Description

Pharmacological interventions in sleep medicine have two fundamental treatment goals: to improve waking function by either improving sleep or increasing energy during alertness. Amphetamine derivatives, modafinil, and caffeine are examples of stimulants that improve waking function. From benzodiazepine hypnotics to over-the-counter antihistamines, sleep aids fall into various categories. Other drugs used in sleep medicine include those that were originally prescribed for other conditions like epilepsy, Parkinson's disease, and psychiatric issues. It's critical to understand the distribution of side effects, drug interaction patterns, metabolism, and cytochrome substrate activity because these drugs are administered or encountered by providers in a variety of specialities of medicine.

When compared to conditions that include tiredness as a secondary symptom of sleep disruption, primary hypersomnia’s are rare. When a patient complains of tiredness, it's vital to look into possible fundamental causes, such as sleep apnea or insomnia. The cytochrome P450 (CYP) family of heme-containing enzymes is involved in both endogenous and external organic compound metabolism. These proteins, which are mostly located in the liver, oxidise their substrates, which is a crucial step in metabolism. A single medication may interact with one or more CYP enzymes, and each CYP enzyme may catalyse the metabolism of numerous drugs. The CYP3A4 isozyme may start the metabolism of medicines in the intestine before they reach the liver. In clinical pharmacology, there are two main contexts for considering CYPs. The effect of certain drugs on enhancing or inhibiting the action of one or more CYP enzymes, which may alter the metabolism of shared substrate drugs, is the most clinically relevant.

The other background is a growing knowledge that genetic variations can affect a person's medication metabolism. The ultra-rapid metabolizer phenotype is caused by gene duplication or amplification. These traits could have a big impact on drug research, clinical trial design, and clinical treatment. Drug interactions with the CYP system can have a wide range of consequences, from dose changes to the possibility of serious side effects. Another factor to consider is age, as advanced age has been linked to decreased CYP activity. The CYP system can also be affected by liver and cardiac failure. A CYP enzyme's inhibition might be reversible or irreversible. If two medications are substrates for the same CYP enzyme, the drug with the more potent interaction will undergo more extensive metabolism, whereas the CYP substrates with the less potent interaction would undergo less metabolism. This type of competitive CYP inhibition raises serum levels of the less effective medication, which could have serious side effects.

Increased CYP enzyme synthesis or an increase in the rate of enzymatic metabolism of existing proteins can both result in CYP enzyme induction. Inducible CYP1A2, CYP2C9, CYP2E1, and CYP3A4 enzymes If synthesis is involved, induction may be gradual, whereas inhibition is more acute. The substrate or inhibitor status is indicated in each situation, as well as whether it is substantial or small (the former obviously requiring closer consideration). A single CYP enzyme is both a substrate and an inhibitor for some medicines (e.g., nefazodone with 3A4). Most sleeping medications, for example, are substrates for CYP 3A4, which is involved in the metabolism of many common pharmaceuticals (such as the statins atorvastatin and simvastatin), a reminder that combination therapy may necessitate dose adjustments or revaluation of the risk-benefit ratio. Modafinil and 2C19, which metabolises proton pump inhibitors, are another example.

This article concludes that many patients with sleep difficulties also have concomitant medical and psychiatric conditions; the CYP issues discussed here should be compared to those for the rest of their drugs, according to this article. Non-prescription medicines, as well as some foods and natural supplement products, may have an effect on the CYP system.