NEUROPSYCHIATRIC ADVERSE EFFECTS OF NEWER SEDATIVE HYPNOTICS: A SYSTEMATIC REVIEW

PRANAB DAS; DARADI DAS; ROHIT TIGGA

doi:10.22159/ijpps.2025v17i9.55462

Authors

PRANAB DAS Department of Pharmacology, Pragjyotishpur Medical College and Hospital, Guwahati, Assam, India https://orcid.org/0009-0009-0229-3277
DARADI DAS Department of Pharmacology, Pragjyotishpur Medical College and Hospital, Guwahati, Assam, India
ROHIT TIGGA Department of Pharmacology, Silchar Medical College and Hospital, Silchar, Assam, India

DOI:

https://doi.org/10.22159/ijpps.2025v17i9.55462

Keywords:

Zolpidem, Z-drugs, Suvorexant, Neuropsychiatric ADRs, Insomnia, Sedatives, Hypnotics, Adverse drug reactions, Qualitative synthesis, Systematic review

Abstract

This systematic review aimed to evaluate and synthesise existing evidence on neuropsychiatric adverse drug reactions (ADRs) associated with newer sedative-hypnotics, particularly the Z-drugs (zolpidem, zopiclone, eszopiclone, zaleplon) and the dual orexin receptor antagonist suvorexant. The review sought to identify common adverse drug reaction (ADR) patterns, determine high-risk populations, and assess the neuropsychiatric safety profiles of these agents.

A comprehensive literature search was conducted across databases including PubMed, Scopus, Web of Science, and Google Scholar (limited to the first 200 results). Eligible studies included observational studies, pharmacovigilance reports, randomised controlled trials, and systematic reviews reporting neuropsychiatric adverse drug reactions (ADRs) linked to the target medications in adult population. Data extraction and screening were performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. A qualitative thematic synthesis approach was adopted due to heterogeneity in outcome measures and study designs.

Out of 20 identified records, 9 studies met the inclusion criteria for core synthesis. The most frequently reported neuropsychiatric ADRs included sleepwalking, hallucinations, suicidality, and falls. Zolpidem was implicated in the widest range of reactions, followed by zopiclone and eszopiclone. Suvorexant exhibited a comparatively milder adverse drug reaction (ADR) profile, although somnolence and hallucinations were still observed. Elderly individuals, psychiatric patients, and those using high doses or non-prescribed medications emerged as particularly high-risk populations.

In conclusion, newer sedative-hypnotics, especially Z-drugs, are associated with a diverse spectrum of neuropsychiatric adverse effects, warranting caution in vulnerable populations.

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