Why does ranitidine cause insomnia

This class of drugs can improve alertness during the day, but they are often associated with reports of daytime sleepiness. Insomnia is also described. It is always difficult to analyze the effects of antidepressants on the sleep-wake cycle because the disease itself leads to sleep disturbance specifically, sleepiness or insomnia and other symptoms that overlap with the sleep disturbance: lassitude, fatigue, and decreased cognitive performance.

Sedative effects are also reported with the use of MAOIs Selective serotonin reuptake inhibitors SSRIs - Although they show selectivity in inhibiting serotonin uptake, they act weakly in inhibiting the reuptake of norepinephrine and dopamine and antagonize muscarinic cholinergic receptors. These drugs have different actions on several subtypes of serotonin receptors and may cause sleepiness sedation or insomnia as adverse effects.

Fluoxetine, the most studied SSRI antidepressant to date, most often causes insomnia Paroxetine most often causes sedation, although it may cause insomnia in some patients 36, These drugs can cause insomnia or sleepiness The most important effect of trazodone is sedation; due to this effect, it is indicated as a hypnotic in low doses mg Its efficacy as an antidepressant in severe depression is greater than fluoxetine 43 ; it may cause insomnia It produces sedation most likely by its high antagonistic affinity to histamine H1 receptor antihistaminic effect.

With an unusual mechanism of action for this drug group, it acts as an agonist of melatonin receptors MT1 and MT2 and assists in restoring circadian rhythm. Both insomnia and sleepiness are common and transient symptoms in the first two weeks of agomelatine use 45, Lithium - A drug of first choice for all stages of bipolar disorder.

At the onset of treatment, it is subjectively associated with improvement of nighttime sleep and increased daytime sleepiness Epilepsy affects over 50 million people worldwide, with over 40 clinical syndromes already described. Currently, strategies for treatment of this disease are only symptomatic, not curative, aiding in the suppression of clinically manifested seizures with either mono-or poly-drug therapy.

Since the s, 10 new anticonvulsants have been approved for additional treatment of partial seizures. The mechanisms of action of anticonvulsants include sodium channel blockade on the neuronal cytoplasmic membrane level, effects on gamma-aminobutyric acid GABA action agonism of receptors and reuptake and transaminase inhibition , blockade of glutamate receptors, and other mechanisms, several of which are unknown According to controlled placebo studies, they cause mainly sedation at the begging of treatment 52, Lamotrigine, in addition to its sedative effect, can also cause insomnia Moreover, they show muscarinic anticholinergic effects, central alpha-adrenergic action, and serotonergic effects.

They cause sedative effects significant enough that they are indicated as hypnotics by some professionals off-label. Therefore, they exert little effect on the central nervous system. A meta-analysis of 18 studies 58 concluded that second-generation antihistamines cause much less sedative effects than the first-generation antihistamines, although mild sedation has been detected.

Among the second-generation drugs, cetirizine is cited as showing a greater subjective sedative effect. However, these drugs can interact with other classes of drugs that have sedative effects carbamazepine and benzodiazepines or insomnia effects theophylline and beta-blockers , increasing their levels and adverse effects.

Pseudoephedrine is often used in association with analgesics or antihistamines, indicated as nasal decongestants in rhinitis, and over-the-counter in cold medication. The major sleep disorder reported with the use of pseudoephedrine is insomnia Several studies and subjective reports describe an increased incidence of insomnia with the use of these stimulants; cognitive functions may improve as an effect of these drugs Antipsychotics - The antipsychotics classically act by antagonizing dopamine D2 receptors in the mesolimbic system In addition to blocking dopamine D2 receptors, they antagonize the serotonin receptors especially 5-HT2A Antipsychotics, formerly called neuroleptics or major tranquillizers 63 , effect some blockade of alpha-adrenergic, muscarinic cholinergic, and histamine receptors, which gives them a sedative property to a greater or lesser degree, depending on the action at these sites Among the classical drugs, chlorpromazine and thioridazine are more sedative than haloperidol.

Aripiprazole is the one that shows the least sedation. Insomnia may be caused by typical and atypical antipsychotics. This symptom is attributed to their ability to act as agonists of serotonergic 5-HT1A receptor or to the restless legs syndrome caused by dopamine blockade, even with the use of atypical antipsychotics Anxiolytic drugs - Several medications are currently used to treat anxiety disorders.

Antidepressants that inhibit serotonin and norepinephrine duloxetine, venlafaxine, and desvenlafaxine , the SSRIs, the benzodiazepines, and buspirone partial 5-HT1A receptor agonist are considered drugs of first choice in the treatment of anxiety disorders Antiepileptic drugs and atypical antipsychotics can also be indicated for use in anxiety. However, buspirone has the great advantage of not causing addiction or sedation; however, it can cause insomnia as an undesirable symptom 68, These complaints tend to worsen with progression of the disease and may result from abnormalities in the sleep-wake cycle, nocturnal motor symptoms, other drugs in use, or even other disorders: sleep apnea, periodic limb movements, or comorbid or psychiatric diseases.

Dopamine replacement is a priority in this disease. Interestingly, this compound has been listed as a better therapeutic option in the treatment of attention deficit-hyperactivity disorder, with similar results and lower rates of side effects than stimulants commonly used in this condition Higher doses of dopaminergic drugs are more likely to be associated with the sedative effect Sudden sleep attacks, which can cause traffic accidents, are also described.

Such attacks, which may occur without previous symptoms, are observed with the use of any dopaminergic agent, but less frequently with levodopa alone In recent years, drugs inhibiting the enzyme that degrades acetylcholine in the synaptic cleft acetylcholinesterase have been developed, enabling a more effective treatment of these patients. The others are indicated for use only in the mild to moderate stages.

Donepezil is the only one with the potential to alter sleep and can be administered in the morning or evening. Donepezil is recommended for use only in the morning in case of insomnia or nightmare Many drugs used in the treatment of chronic diseases have the ability to cause sedation or insomnia as adverse effects. Drugs with higher fat-solubility more easily traverse the blood-brain barrier.

Any drug with activity in the central nervous system has the potential to affect the sleep-wake cycle; preserving the quality and operation of this cycle can be important for successful treatment of the underlying disease.

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Geriatric Diabetes: e-book. Cloridrato de pioglitazona [internet]. J Clin Endocrinol Metab. Blonde L. Current antihyperglycemic treatment strategies for patients with type 2 diabetes mellitus. Subjects were studied under conditions of placebo, cimetidine mg b. Sleep was assessed at the end of each one-week interval via polysomnographic evaluation conducted on nights 6 and 7 of drug administration.

On the day between the two nights in the sleep laboratory, a multiple sleep latency test was conducted. Results: The results revealed a significant reduction in the sleep onset latency with famotidine administration, but since there were no effects of any of the medications in the multiple sleep latency test, this finding is of dubious clinical significance. Sleep disturbance caused by ranitidine is an uncommon adverse event in patients receiving the drug.

However, similar reactions have been observed with other H2 antihistamines such as cimetidine and famotidine. Clinicians should be aware that sleep disturbance secondary to ranitidine is a potential side effect of this medication. Ranitidine is an H2 receptor antagonist that is typically used for the treatment of gastrointestinal conditions such as peptic ulcers or gastroesophageal reflux disease [ 1 ]; however, it is often used as off-label therapy for verruca vulgaris [ 2 ].

We describe a year-old man who developed ranitidine-associated sleep disturbance when the medication was administered as adjunctive therapy for his recalcitrant plantar wart. Similar central nervous system adverse effects from other H2 antihistamines will be reviewed. A year-old man presented for evaluation and treatment of a chronic verrucous lesion on the bottom of his right foot.

The wart had been noted eight years earlier and had not responded to several topical therapies. His past medical history was significant for anaplastic lymphoma kinase ALK -negative anaplastic large cell lymphoma diagnosed three years ago. He was treated with chemotherapy, radiation, and an autologous bone marrow transplant. The most recent restaging scans two months ago had no evidence of relapse.

The patient had no prior history of sleep disorders, including insomnia, narcolepsy, obstructive sleep apnea, and parasomnias. Cutaneous examination of the medial aspect of his right plantar foot showed a verrucous plaque. Once a week he used a pumice stone to manually pare the lesion. Follow-up examination showed slight improvement. However, after continued similar management, the lesion persisted. Imiquimod five percent cream was prescribed to be applied on and around the wart each evening, and systemic adjunctive therapy was started with ranitidine mg twice daily.

Within three days, he developed gastrointestinal and central nervous system reactions. He described the gastrointestinal symptoms as gastroesophageal reflux disease-like with a constant full sensation in the middle of his chest. The central nervous system symptoms consisted of difficulty falling asleep, disturbing dreams, and nighttime awakenings.

In these dreams, he reported having a conversation with another person and being placed in situations that made him uncomfortable or threatened. However, he was unable to recall specific details. He explained that the dreams were bizarre, emotionally disturbing, and nonsensical. After three weeks of twice daily ranitidine, he self-discontinued the medication; both the gastrointestinal and central nervous system symptoms promptly resolved.

Three weeks later, he decided to take the ranitidine again; within one day, both symptoms recurred. Again, after stopping the ranitidine, all symptoms ceased and did not return. H2 receptor blockers are a subclass of antihistamines that include cimetidine, ranitidine, famotidine, and nizatidine.

They were marketed in , , , and respectively. H2 antihistamines are effective in the treatment of peptic ulcer disease, gastroesophageal reflux disease, and hypersecretory conditions by indirectly reducing gastric acid secretion [ 1 ].

Cimetidine and ranitidine have also been used as off-label therapeutic interventions for warts [ 2 ]. Common side effects of H2 antihistamines include gastrointestinal disturbance such as constipation, diarrhea, and nausea , headache, and skin rash. However, central nervous system adverse effects are uncommon [ 1 , 3 ]. Similarly, H1 antihistamines have been reported to cause neuropsychiatric reactions, particularly in the elderly. Due to the relatively low incidence, it is difficult to identify risk factors for central nervous system reactions to H2 antihistamines.

However, review of the literature did not reveal sufficient evidence to suggest that age, H2 blocker dose, hepatic disease, immune status, renal disease, or concurrent use of other medications increased the likelihood of having such reactions.

In , Cantu et al. The neuropsychiatric adverse reactions of cimetidine included agitation, auditory and visual hallucinations, confusion, delirium, disorientation, psychosis, and somnolence [ 1 ]. Albeit less common, there have been two patients who developed nizatidine-associated neuropsychiatric adverse effects.