Published: 13 December 2018

Publications

Parasomnias – A Medicine Nightmare

Prescriber Update 39(4): 61
December 2018

Key Messages

  • Medicines such as beta-blockers, statins, selective serotonin re-uptake inhibitors and nicotine replacement therapies have been associated with various parasomnias.
  • More recently, parasomnias have been reported in association with atypical antipsychotics.

Background

Parasomnia is an umbrella term for complex movements or behaviours during sleep. These can include abnormal dreaming, nightmares (paroniria), sleepwalking (somnambulism) and sleep-related eating disorder1 . Some medicines are known to interfere with non-rapid eye movement (NREM) and/or rapid eye movement (REM) sleep, resulting in parasomnias. These include widely used medicines such as beta-blockers, statins, selective serotonin re-uptake inhibitors (SSRIs) and nicotine replacement therapies2 .

Antipsychotics

At their 174th meeting, the Medicines Adverse Reactions Committee (MARC) reviewed a safety signal of somnambulism and sleep-related eating disorder induced by atypical antipsychotics. Based on the evidence provided, the Committee concluded that there is an association between these events and quetiapine, olanzapine, and ziprasidone. The data sheets for these medicines are currently being updated to include somnambulism and related sleep disorders as adverse effects. Other antipsychotics will continue to be monitored as part of regular pharmacovigilance activities3 .

New Zealand reports

The Centre for Adverse Reactions Monitoring (CARM) has received over 70 reports of various parasomnias over the past 5 years. Although arousal-associated parasomnias typically affect children1 , CARM has received reports of parasomnias from all age groups, associated with various medicines. The most frequently reported terms are:

  • abnormal dreams (n=21)
  • paroniria (n=42)
  • sleep disorder (n=11).

Medicines commonly reported in association with parasomnias include:

  • statins (n=6)
  • varenicline (n=17)
  • montelukast (n=5).
References
  1. Vaughn B. 2018. Approach to abnormal movements and behaviors during sleep. In: UpToDate 6 June 2018. URL: www.uptodate.com/contents/approach-to-abnormal-movements-and-behaviors-during-sleep (accessed 4 October 2018).
  2. Harvard Health Publishing. 2010. Medications that can affect sleep. URL: www.health.harvard.edu/newsletter_article/medications-that-can-affect-sleep/ (accessed 4 October 2018).
  3. Medsafe. 2018. Minutes of the 174th Medicines Adverse Reactions Committee 3 July 2018. URL: www.medsafe.govt.nz/profs/adverse/Minutes174.htm (accessed 4 October 2018).
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