Zaleplon, sold under the brand name Sonata among others, is a sedative and hypnotic which is used to treat insomnia. It is a nonbenzodiazepine or Z-drug of the pyrazolopyrimidine class.
Medical uses
Zaleplon is slightly effective in treating insomnia,
primarily characterized by difficulty falling asleep. Zaleplon significantly reduces the time required to fall asleep by improving sleep latency and may therefore facilitate sleep induction rather than sleep maintenance.
Due to its ultrashort elimination half-life, zaleplon may not be effective in reducing premature awakenings; however, it may be administered to alleviate middle-of-the-night awakenings.
However, zaleplon has not been empirically shown to increase total sleep time.
Zaleplon does not significantly affect driving performance the morning following bedtime administration or 4 hours after middle-of-the-night administration.
Special populations
Zaleplon is not recommended for chronic use in the elderly.
The elderly are more sensitive to the adverse effects of zaleplon such as cognitive side effects. Zaleplon may increase the risk of injury among the elderly. It should not be used during pregnancy or lactation. Clinicians should devote more attention when prescribing for patients with a history of alcohol or drug abuse, psychotic illness, or depression.
In addition, some contend the efficacy and safety of long-term use of these agents remains to be enumerated, but nothing concrete suggests long-term use poses any direct harm to a person.
Adverse effects
The adverse effects of zaleplon are similar to the adverse effects of benzodiazepines, although with less next-day sedation,
and in two studies zaleplon use was found not to cause an increase in traffic accidents, as compared to other
hypnotics currently on the market.
Sleeping pills, including zaleplon, have been associated with an increased risk of death.
Some evidence suggests zaleplon is not as chemically reinforcing and exhibits far fewer rebound effects when compared with other nonbenzodiazepines, or .
Interactions
The CYP3A4
liver enzyme is a minor metabolic pathway for zaleplon, normally metabolizing about 9% of the drug.
CYP3A4 inducers such as
rifampicin,
phenytoin,
carbamazepine, and
phenobarbital can reduce the effectiveness of zaleplon, and therefore the FDA suggests that other hypnotic drugs be considered in patients taking a CYP3A4 inducer.
Additional sedation has been observed when zaleplon is combined with thioridazine, but it is not clear whether this was due to merely an additive effect of taking two sedative drugs at once or a true drug-drug interaction.
Pharmacology
Mechanism of action
Zaleplon is a high-selectivity,
high-affinity ligand of positive modulatory benzodiazepine sites on
GABAA receptor receptors. Zaleplon binds preferentially at benzodiazepine sites on α1-containing GABA
A receptors (previously known as BZ1/Ω1 receptors), which largely mediate the sedative effects of benzodiazepines.
However, unlike
zolpidem, zaleplon binds with appreciable affinity to benzodiazepine sites on some α2 and α3-containing GABA
A receptors, which are implicated in the anxiolytic and muscle relaxant effects of benzodiazepines. Zaleplon demonstrates greater selectivity at these sites than
lorazepam or
zopiclone.
Unlike nonselective benzodiazepine drugs and zopiclone, which distort the sleep pattern, zaleplon appears to induce sleep without disrupting the normal sleep architecture.
A meta-analysis of randomized, controlled clinical trials which compared benzodiazepines against zaleplon or other Z-drugs such as zolpidem, zopiclone, and eszopiclone has found few clear and consistent differences between zaleplon and the benzodiazepines in terms of sleep onset latency, total sleep duration, number of awakenings, quality of sleep, adverse events, Drug tolerance, rebound insomnia, and daytime alertness.
Zaleplon should be understood as an ultrashort-acting sedative-hypnotic drug for the treatment of insomnia. Zaleplon increases EEG power density in the δ-frequency band and a decrease in the energy of the θ-frequency band.
Pharmacokinetics
The ultrashort 1hr
half-life gives Zaleplon a unique advantage over other hypnotics because of its lack of next-day residual effects on driving and other performance-related skills.
Zaleplon is primarily metabolised by aldehyde oxidase into 5-oxozaleplon, and its half-life may be affected by substances which inhibit or induce aldehyde oxidase. According to urine analysis, about 9% of zaleplon is metabolized by CYP3A4 to form desethylzaleplon, which is quickly metabolized by aldehyde oxidase to 5-oxodesethylzaleplon.
Chemistry
Zaleplon is classified as a pyrazolopyrimidine.
Pure zaleplon in its solid state is a white to off-white powder with very low
solubility in water, as well as low solubility in
ethanol and
propylene glycol.
It has a constant octanol-water partition coefficient of log P = 1.23 in the pH range between 1 and 7.
Synthesis
The synthesis starts with the condensation of 3-acetylacetanilide
(
1) with
N,
N-dimethylformamide dimethyl acetal (
DMFDMA)
to give the eneamide (
2). The anilide nitrogen is then alkylated by means of
sodium hydride and
ethyl iodide to give
3. The first step in the condensation with 3-amino-4-cyanopyrazole can be visualized as involving an addition-elimination reaction sequence on the eneamide function to give a transient intermediate such as
5. Cyclization then leads to the formation of the fused
pyrimidine ring to afford zaleplon (
6).
Society and culture
Recreational use
Zaleplon has the potential to be a drug of recreational use, and has been found to have an addictive potential similar to benzodiazepine and benzodiazepine-like hypnotics.
Some individuals use a different delivery method than prescribed, such as insufflation, to induce effects faster.
Anterograde amnesia can occur and can cause one to lose track of the amount of zaleplon already ingested, prompting the ingesting of more than originally planned.
Aviation use
The Federal Aviation Administration allows zaleplon for pilots with a 12-hour wait period before flying and no more than twice a week, which makes it the sleep medication with the shortest allowed waiting period after use.
The substances with the 2nd shortest period, which is of 24 hours, are zolpidem and
ramelteon.
Military use
The United States Air Force uses zaleplon as one of the hypnotics approved as a "
no-go pill" to help aviators and special-duty personnel sleep in support of mission readiness (with a four-hour restriction on subsequent flight operation). "Ground tests" are required prior to authorization being issued to use the medication in an operational situation.
The other hypnotics used as "no-go pills" are
temazepam and
zolpidem, which both have longer mandatory recovery periods.
