ReviewJournal of medical toxicology : official journal of the American College of Medical Toxicology2013
In the Zzz zone: the effects of Z-drugs on human performance and driving.
Review in Journal of medical toxicology : official journal of the American College of Medical Toxicology, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 57 papers, 6 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
57 citing papers in PubMed, 6 syntheses or guidelines pooled it, 175 citations in OpenAlex.
- Effects of Agomelatine on Sleep Across Populations: A Systematic Review and Meta-Analysis.Journal of sleep research · 2026Pooled it
- Benzodiazepines and Related Drugs as a Risk Factor in Alzheimer's Disease Dementia.Frontiers in aging neuroscience · 2019Pooled it
- Eszopiclone for insomnia.The Cochrane database of systematic reviews · 2018Pooled it
- Efficacy and tolerability of Z-drug adjunction to antidepressant treatment for major depressive disorder: a systematic review and meta-analysis of randomized controlled trials.European archives of psychiatry and clinical neuroscience · 2017Pooled it
- Medication use and the risk of motor vehicle collisions among licensed drivers: A systematic review.Accident; analysis and prevention · 2016Pooled it
- Zolpidem use and risk of fractures: a systematic review and meta-analysis.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2016Pooled it
- Effect of magnetic stimulation of Shenmen point on cognitive function of chronic insomnia: A randomized controlled clinical trial.Medicine · 2020Trial
- Enhancement of zaleplon oral bioavailability using optimized self-nano emulsifying drug delivery systems and its effect on sleep quality among a sample of psychiatric patients.Drug delivery · 2019Trial
- A randomized, double-blind, single-dose, placebo-controlled, multicenter, polysomnographic study of gabapentin in transient insomnia induced by sleep phase advance.Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine · 2014Trial
- Z-Drug Use and All-Cause Mortality: A Meta-Analysis of Observational Cohort Studies.Neuropsychiatric disease and treatment · 2026Article
- Residual Effects of Acute and Subchronic Zolpidem Treatments on Attentional Processes in Aged Female Rats.Fundamental & clinical pharmacology · 2026Article
- Early small bowel obstruction by phytobezoar related to zopiclone induced amnesia after revisional Roux-en-Y gastric bypass: a case report.Journal of surgical case reports · 2025Article
- GPs' reflections on prescribing addictive hypnotics to older people: a qualitative study.BJGP open · 2024Article
- A scoping review of motor vehicle operator performance assessments for benzodiazepine receptor agonists.Exploratory research in clinical and social pharmacy · 2024Article
- Emerging and upcoming therapies in insomnia.Translational and clinical pharmacology · 2024Article
- Gut microbiome and metabolic pathways linked to sleep quality.Frontiers in microbiology · 2024Article
- A Review of Drug Abuse, Misuse, and Related Laboratory Challenges.Current drug safety · 2024Review
- Effects of Japanese policies and novel hypnotics on long-term prescriptions of hypnotics.Psychiatry and clinical neurosciences · 2023Article
- Discovery of Small-Molecule Antagonists of Orexin 1/2 Receptors from Traditional Chinese Medicinal Plants with a Hypnotic Effect.Pharmaceuticals (Basel, Switzerland) · 2023Article
- The abuse potential of lemborexant, a dual orexin receptor antagonist, according to the 8 factors of the Controlled Substances Act.Psychopharmacology · 2023Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
1 author at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Despite their improved pharmacokinetic profile, the Z-drugs, zolpidem, zopiclone, and zaleplon, have a spectrum of adverse effects comparable to benzodiazepines. This review focuses on the impairment from Z-drugs on cognition, behavior, psychomotor performance, and driving ability. Z-drugs are short-acting GABA agonists that reduce sleep latency without disturbing sleep architecture. Bizarre behavioral effects have prompted warnings on the prescription, dispensation, and use of Z-drugs. Psychomotor impairment, falls, and hip fractures are more likely to occur with Z-drugs that have longer half-lives, that are taken at higher-than-recommended doses and when mixed with other psychoactive substances including alcohol. Zopiclone and higher doses of zolpidem are more likely to cause anterograde amnesia than zaleplon. Z-drugs, especially zolpidem, are associated with complex behaviors such as sleepwalking, sleep-driving, and hallucinations. Patients taking zopiclone and zolpidem have an increased risk of motor vehicle collisions, over double that of unexposed drivers. Driving impairment occurs with zopiclone and higher doses of zolpidem but is unlikely to occur after 4 h post-zaleplon administration. The residual effect of Z-drugs on next-day cognitive and psychomotor performance has significant impact on lifestyle, safety, and occupational considerations, including motor vehicle and machine operation. The risk-benefit analysis of Z-drugs in the treatment of insomnia, particularly in the elderly, may not favor treatment due to the increased risks of falls and motor vehicle collisions. Prescribers should warn patients taking Z-drugs of minimum time thresholds before they operate machinery or drive motor vehicles.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.