Sedative

What is a sedative?

A sedative is any prescription medication that slows the activity of (depresses) your central nervous system (your brain and spinal cord). Sedatives have a wide range of uses. Their potency (strength) and how long they last (duration) vary considerably.

Examples of the effects of sedatives include:

• Relaxed feeling.
• Decreased anxiety.
• Decreased intensity of sensations, like pain and touch.
• Drowsiness.
• Shallow breathing.
• Slowed heart rate.
• Decreased muscle function.
• Interruptions in your memory.

The medical world often associates sedatives with hypnotic drugs. Sometimes, they group them together to form one class: sedative-hypnotics.

Several drugs have sedative side effects (like antihistamines and neuroleptic medications), but the effect is mild enough that providers generally don’t consider them part of the sedative drug class.

Sedatives can have dangerous effects, especially if you misuse them. They have addiction potential and can be habit-forming. Because of this, healthcare providers prescribe sedatives cautiously. It’s important to take your sedative medication exactly as prescribed. Misuse of prescription sedatives can result in substance use disorder and overdose.

What is sedation?

Sedation is a state of calmness, relaxation or sleepiness as a result of certain sedative medications. It’s also known as conscious sedation, twilight sedation or monitored anesthesia care.

In a medical setting, sedation most commonly goes hand in hand with procedures or surgeries. An example of this is sedation dentistry. Healthcare providers use sedation to help relieve anxiety during procedures or to help you cope with very stressful events.

Sedation always involves sedative drugs, but not all sedative drugs are used for full medical sedation. Some people take prescription sedatives for certain medical conditions, like insomnia or anxiety.

There are three levels of sedation:

• Minimal: Minimal sedation helps you relax, but you’ll likely be awake. You’ll be able to answer questions and follow directions easily.
• Moderate: Moderate sedation makes you feel drowsy. You may even fall asleep. You may or may not remember parts of the procedure. You’ll be able to answer questions and follow directions.
• Deep: Deep sedation makes you fall asleep. But it doesn’t make you lose consciousness as general anesthesia does. You’ll probably have little or no memory of the procedure.

What’s the difference between sedation and anesthesia?

Sedation is a decrease in awareness and a decrease in response to external stimulation. By itself, it results in calmness and relaxation. General anesthesia is a reversible and controlled loss of consciousness. General anesthesia involves sedation, the inability to feel pain (analgesia), temporary amnesia and temporary muscle paralysis.

Healthcare providers use sedation for minor surgeries or shorter, less complex procedures. General anesthesia is necessary for major surgeries, like open heart surgery, or for children who may not be able to remain still during minor procedures.

What are sedatives used for?

Healthcare providers prescribe sedatives for several different conditions, some of which include:

• Anxiety disorders.
• Seizures.
• Panic disorders.
• Sleep disorders, like insomnia.
• Bipolar disorder.
• Spasticity.

Providers also use specific sedatives to help achieve sedation for certain procedures and minor surgeries. They also use them as part of general anesthesia.

What are the types of sedatives?

The main groups of sedatives include:

• Benzodiazepines.
• Barbiturates.
• Hypnotics (nonbenzodiazepines).
• Miscellaneous sedatives.

Benzodiazepines

Benzodiazepines are depressant drugs that slow down the messages that travel between your brain and your body. Healthcare providers mainly prescribe them for anxiety disorders, insomnia and seizures.

Examples of benzodiazepines include:

• Alprazolam (Xanax®).
• Flurazepam (Dalmane®).
• Triazolam (Halcion®).

Barbiturates

Barbiturates are medications that cause you to relax or feel drowsy. They can also stop or prevent seizures. The most common uses are for anesthesia purposes and treating seizures and insomnia.

Examples of barbiturates include:

• Methohexital (Brevital®).
• Pentobarbital (Nembutal®).
• Phenobarbital (Luminal Sodium®, Solfoton®, Tedral®).

Hypnotics (nonbenzodiazepines)

These are medications that mimic hypnotic effects and work similarly to benzodiazepines, but they aren’t the same. These drugs are most effective in treating insomnia and related sleep disorders. They include:

• Eszopiclone (Lunesta®).
• Zaleplon (Sonata®).
• Zolpidem (Ambien®).

Providers sometimes call these “Z-drugs.”

Miscellaneous sedatives

Other sedative medications that don’t fit into the other categories include:

• Ramelteon (Rozerem®): This is a melatonin agonist medication that helps treat insomnia.
• Suvorexant (Belsomra®): This is an orexin antagonist medication that helps treat insomnia. Orexin is a neuropeptide that regulates arousal, wakefulness and appetite.

Opioids also have mild sedative effects. Providers may use them alongside benzodiazepines for added sedation.

What is the most common sedative?

Benzodiazepines are the most common group of prescribed sedatives. The most commonly prescribed benzodiazepines are diazepam (Valium®) and alprazolam (Xanax®).

How do sedatives work?

Sedatives work by disrupting certain nerve communications in your central nervous system. This slows down your brain’s activity.

More specifically, sedatives boost the activity of gamma-aminobutyric acid (GABA). GABA is an inhibitory neurotransmitter that slows down your brain. Increased GABA activity results in a decrease in brain activity.

Each sedative has different levels of potency. Some sedatives only slow down your brain’s activity a little bit, while others can decrease your brain activity enough to put you in a controlled state of unconsciousness.

What should I tell my healthcare provider before taking a sedative?

Before you start taking a sedative, you should discuss the following topics with your healthcare provider:

• Whether other medicines or therapies might treat your condition.
• The risks and benefits of taking a sedative.
• Your medical history.
• If you or anyone in your family have a history of substance use or substance use disorder.
• Any other medicines and supplements you’re taking, which may interact with the sedative.
• If you drink alcohol.
• If you’re pregnant or planning to become pregnant.
• If you use marijuana/cannabis (prescription or otherwise).
• If you use any other substances.

What are the side effects of sedatives?

Short-term side effects of sedatives include:

• Sleepiness.
• Dizziness.
• Difficulty focusing or thinking.
• Blurred vision.
• Impaired depth perception.
• Slowed reaction times and reflexes.
• Not feeling pain the way you usually do.

What are the risks or complications of sedatives?

Risks and complications of sedatives include:

• Long-term complications.
• Addiction potential.
• Toxicity and overdose.
• Withdrawal.

Long-term complications

Long-term sedative use can lead to the following complications:

• Frequent forgetfulness or losing your memory.
• Depression symptoms, such as fatigue, feelings of hopelessness or suicidal thoughts.
• Liver issues or liver failure.
• Developing a dependency on sedatives, which can lead to withdrawal symptoms if you stop using them abruptly. Sedative withdrawal can be life-threatening. You must talk to your provider if you think you’re developing a dependency. Never stop taking them abruptly.

Addiction potential

The main reason sedatives have a high addiction potential is that some of them can create a sense of euphoria (intense happiness), which many people find pleasurable.

People who use sedatives regularly can soon develop tolerance to these effects. They may then use more and more of the drug in an attempt to get the original intensity of symptom relief and euphoria. Chronic use or misuse of prescription sedatives can lead to mental (psychological) and physical dependence.

People are psychologically dependent when a drug is so central to their thoughts, emotions and activities that the need to continue its use becomes a craving or compulsion despite negative consequences.

With physical dependence, your body has adapted to the presence of the drug, and withdrawal symptoms happen if you suddenly stop taking the drug or you take a reduced dosage.

People who are physically dependent on sedatives experience withdrawal symptoms when they stop taking the drug. These symptoms are often unpleasant, so they may be more likely to take more of the drug to stop the withdrawal symptoms.

Sedative use disorder is a common substance use disorder in the United States. Experts estimate that 5 million or more people in the U.S. misuse sedatives.

Sedative use disorder (SUD) can significantly impact your health, relationships and overall quality of life. It can also be life-threatening. It’s crucial to seek help as soon as you develop signs of SUD.

Sedative use disorder prevention

Ways to prevent sedative use disorder include:

• Follow the instructions for your prescription sedative. Never take more than instructed by your provider.
• Never share your prescription medication with someone else or sell your medication.
• Always store your sedative medication in a safe and secure place away from children.
• If you have leftover sedative medications at the end of your treatment, find a community drug take-back program or pharmacy mail-back program to safely dispose of them.

Toxicity and overdose

It’s possible to develop toxic levels of a benzodiazepine if you take inappropriate amounts (such as more than the prescribed amount). In addition, if you take a benzodiazepine with another substance, such as a different sedative, opioid or alcohol, it can result in overdose and possibly death.

Symptoms of sedative overdose include:

• Profound sedation.
• Slurred speech.
• Ataxia.
• Respiratory depression.
• Coma.

Call 911 or get to the nearest emergency room if you or someone you know are experiencing these symptoms. Sedative overdose can be fatal if it’s not treated in time.

Withdrawal

If you take your prescription sedative medication exactly as instructed by your healthcare provider, you shouldn’t experience withdrawal symptoms once you’ve finished your course of medication.

If you misuse sedatives and stop or cut back on these drugs after heavy use for a few weeks or more, you’ll likely have withdrawal symptoms, including:

• Anxiety.
• Loss of appetite.
• Tremors.
• Night terrors.
• High fever.
• Increased heart rate.
• Rapid breathing.
• Seizures.

Withdrawal can be a life-threatening emergency that may require hospitalization. Keep your provider informed of any symptoms of sedative withdrawal you may be experiencing.

Other complications

Sedatives slow down your nerve signals and reflexes, so they can affect your ability to drive or do certain tasks safely. Your healthcare provider will tell you whether or not it’s safe to drive if you take a sedative medication.

Sedatives can also negatively affect fetal development. Talk to your provider if you’re pregnant or thinking of becoming pregnant and take a sedative.

When should I call my healthcare provider?

Ask your healthcare provider how often you should see them while you’re taking a prescribed sedative.

Talk to your provider if:

• The medication isn’t working as it should.
• The side effects are disrupting your usual routine and activities.
• You think you’re developing a dependency on the sedative.
• If you’re thinking of stopping a sedative.

A note from Cleveland Clinic

Sedatives have several uses, from treating anxiety and insomnia to anesthesia purposes. While these medications can treat many conditions, they’re not without risks. If your healthcare provider prescribes a sedative, don’t hesitate to ask for guidance, and be sure to take the medications exactly as prescribed. That way, you can benefit from these medications and reduce the risk of problems along the way.