Flunitrazepam Health Dictionary

These are drugs that induce SLEEP. Before a hypnotic is prescribed, it is vital to establish – and, where possible, treat – the cause of the insomnia (see under SLEEP, DISORDERS OF). Hypnotics are most often needed to help an acutely distressed patient (for example, following bereavement), or in cases of jet lag, or in shift workers.

If required in states of chronic distress, whether induced by disease or environment, it is especially important to limit the drugs to a short time to prevent undue reliance on them, and to prevent the use of hypnotics and sedatives from becoming a means of avoiding the patient’s real problem. In many cases, such as chronic depression, overwork, and alcohol abuse, hypnotics are quite inappropriate; some form of counselling and relaxation therapy is preferable.

Hypnotics should always be chosen and prescribed with care, bearing in mind the patient’s full circumstances. They are generally best avoided in the elderly (confusion is a common problem), and in children – apart from special cases. Barbiturates should not now be used as they tend to be addictive. The most commonly used hypnotics are the BENZODIAZEPINES such as nitrazepam and temazepam; chloral derivatives, while safer for the few children who merit them, are generally second choice and should be used in the lowest possible dose for the minimum period.

Side-effects include daytime drowsiness – which may interfere with driving and other skilled tasks – and insomnia following withdrawal, especially after prolonged use, is a hazard. Occasionally benzodiazepines will trigger hostility and aggression. Zolpidem and zopiclone are two drugs similar to the benzodiazepines, indicated for short-term treatment of insomnia in the elderly. Adverse effects include confusion, incoordination and unsteadiness, and falls have been reported.

FLUNITRAZEPAM is a tranquilliser/hypnotic that has been misused as a recreational drug.... hypnotics

A criminal o?ence in which sexual intercourse takes place with an unwilling partner, female or male, under threat of force or violence. Reported rape cases have increased in number in recent years, but it is hard to know whether this is because the incidence of rape has increased or because the victims – women and men – are more willing to report the crime. A more sympathetic and understanding approach by the police, courts and society generally has resulted in the provision of greater support for victims who are usually severely traumatised psychologically as well as physically. It is argued that rape is motivated by a desire to dominate rather than simply an attempt to achieve sexual grati?cation. The majority of rapes are probably unreported because of the victims’ shame, anxiety about publicity and fear that the rapist will take reprisals. It is legally recognised that rape can happen within marriage. There are moves to make court proceedings less traumatic for victims, whose attackers are often known to them.

Anxiety, DEPRESSION and POST-TRAUMATIC STRESS DISORDER (PTSD) are common after rape: many victims are now given help by rape crisis counselling. A recent report suggests that in at least 50 per cent of reported rapes, the attacker was known to, or had been a friend of, the victim. The deliberate misuse of alcohol or drugs to reduce a potential victim’s resistance seems to be increasing (see DRUG ASSISTED RAPE; FLUNITRAZEPAM.)... rape

See FLUNITRAZEPAM.... rohypnol

Linn.

Family: Valerianaceae.

Habitat: Native to Eurasia. (V officinalis auct. non Linn. is found in Kashmir at Sonamarg at 2,4002,700 m)

English: Valerian, Garden Heliotrope, Common Valerian.

Ayurvedic: Tagara, Nata. Baalaka (syn. Udichya, Jala, Barhishtha) is also equated with Valeriana sp.

Folk: Sugandhabaalaa, taggar.

Action: Tranquillizer, hypnotic, a natural relaxant to higher nerve centres. Used for nervous tension, sleeplessness, restlessness, palpitation, tension, headache, migraine, menstrual pain, intestinal cramps, bronchial spasm.

Key application: Internally for restlessness and sleeping disorders based on nervous conditions (German Commission E). (See Expanded Commission E, ESCOP and WHO monographs.)

Constituents of the root include val- trates, didrovaltrates and isovalerates. Other constituents include 0.4-1.4% monoterpenes and sesquiterpenes, caf- feic, gamma-aminobutyric (GABA) and chlorogenic acids, beta-sitosterol, methyl, 2-pyrrolketone, choline, tannins, gums alkaloids and resin. (Expanded Commission E Monographs.)

The volatile oil (0.5-2%) contains bornyl acetate and bornyl isovalerate as the principal components. Other constituents include beta-caryophyllene, valeranone, valerenal, valerenic acid and other sesquiterpenoids and mono- terpenes.

The co-occurrence of three cyclo- pentane-sesquiterpenoids (valerenic acid, acetoxyvalerenic acid and valere- nal) is confined to Valeriana officinalis L. and permits its distinction from V edulis and V. Wallichii. (WHO.)

The important active compounds of valerian are the valepotriates (iridoid molecules) and valeric acid. Originally it was thought that valepotriates were responsible for the herbs sedative effect, but, later on, an aqueous extract of the root has also been shown to have a sedative effect. Since valepotriates are not soluble in water, it was concluded that valerenic acid is also the chemical factor responsible for the sedative effect of the herb. Most commercial extracts in Western herbal are water-soluble extracts standardized for valerenic acids.

Large doses ofvalepotriates from the herb decreased benzodiazepines and diazepam withdrawl symptoms in rats. At low doses valerian enhances binding of flunitrazepam, but at high doses it inhibits binding of the drug. Valerenic acid inhibits breakdown of GABA, and hydroxypinoresinol binds to benzodi- azepine receptor. (Sharon M. Herr.)

The safety of valepotriates has been questioned.

Currently valerian is an approved over-the-counter medicine in Germany, Belgium, France, Switzerland and Italy. (The British Herbal Compendium.)

See Valeriana dubia Bunge, syn. V. officinalis auct. non Linn., known as Common Valerian.... valeriana officinalis