Sedative-hypnotics: pharmacology and use.

The quest for an ideal sedative-hypnotic drug has been fraught with failure. The goals of the perfect sedative-hypnotic drug are to: (1) produce a transient reduction in the level of consciousness for the purpose of sedation, calmness, and tranquility without lingering aftereffects; (2) produce sleep without the potential to arrest respirations and without aftereffects on sensorium and mood; and (3) produce no abuse, addiction, tolerance, or dependence. Nonetheless, clinical conditions have required the use of sedative-hypnotic drugs in spite of the inherent difficulties with them. The history of sedative-hypnotic drugs is replete with attempts to produce a safe and effective drug. The introduction of one sedative-hypnotic drug for another has been heralded by unguarded optimism and misguided claims. History has repeated itself with each new drug. Toxicities, abuse, addiction, and development of tolerance and dependence have remained in force for each drug that has appeared on the market. Only minor variations on a theme have differentiated one drug from another as the essential features have remained in force.