{"id":1362,"date":"2021-11-28T14:28:44","date_gmt":"2021-11-28T13:28:44","guid":{"rendered":"https:\/\/sfrms-app.fr\/?p=1362"},"modified":"2022-11-06T16:59:51","modified_gmt":"2022-11-06T15:59:51","slug":"les-hypnotiques","status":"publish","type":"post","link":"https:\/\/sfrms-app.fr\/index.php\/2021\/11\/28\/les-hypnotiques\/","title":{"rendered":"Les hypnotiques"},"content":{"rendered":"<h2><span style=\"font-size: 14pt;\">Mode d&rsquo;action<\/span><\/h2>\n<ul>\n<li>Les traitements hypnotiques sont des traitements <a href=\"https:\/\/sfrms-app.fr\/index.php\/glossary\/psychotropes\/\" title=\"Glossary: Psychotropes\" class=\"glossaryLink\">psychotropes<\/a> ayant comme caract&eacute;ristique essentielle <strong>d&rsquo;induire le <a href=\"https:\/\/sfrms-app.fr\/index.php\/glossary\/sommeil\/\" title=\"Glossary: Sommeil\"  class=\"glossaryLink\">sommeil<\/a><\/strong>.<\/li>\n<li>Il s&rsquo;agit de traitement dont la voie d&rsquo;administration est essentiellement orale.<\/li>\n<li>Les principales classes d&rsquo;hypnotiques utilis&eacute;es sont:\n<ul>\n<li>Les hypnotiques de type benzodiaz&eacute;piniques avec notamment:\n<ul>\n<li>Le Loprazolam &ndash; HAVLANE&reg;.<\/li>\n<\/ul>\n<\/li>\n<li>Les hypnotiques apparent&eacute;s aux <a href=\"https:\/\/sfrms-app.fr\/index.php\/glossary\/benzodiazepines\/\" title=\"Glossary: Benzodiaz&eacute;pines\" class=\"glossaryLink\">benzodiaz&eacute;pines<\/a> ou m&eacute;dicament dit &laquo; en Z &raquo; :\n<ul>\n<li>Le Zolpidem &ndash; STILNOX&reg;,<\/li>\n<li>La Zopiclone &ndash; IMOVANE&reg;.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<li>Tous ces hypnotiques agissent en activant les r&eacute;cepteurs GABA des structures impliqu&eacute;es dans le sommeil (VLPO). Les &laquo; <a href=\"https:\/\/sfrms-app.fr\/index.php\/glossary\/z-drug\/\" title=\"Glossary: Z Drug\"  class=\"glossaryLink\">Z Drug<\/a> &raquo;, par leur action sp&eacute;cifique sur la sous unit&eacute; alpha 1 du r&eacute;cepteur GABA, serait plus sp&eacute;cifique de ces structures que les benzodiaz&eacute;pines &laquo; non Z &raquo;. Cf. Fiche : <a href=\"https:\/\/sfrms-app.fr\/index.php\/2021\/12\/14\/physiologie-de-leveil-et-de-lendormissement\/\"><strong>Syst&egrave;me Flip-Flop<\/strong><\/a>.<\/li>\n<\/ul>\n<h2><span style=\"font-size: 14pt;\">Indications<\/span><\/h2>\n<p>Trouble insomnie aigu&euml;<\/p>\n<ul>\n<li>Hypnotique &agrave; demi vie courte si plainte d&rsquo;insomnie, d&rsquo;<a href=\"https:\/\/sfrms-app.fr\/index.php\/glossary\/endormissement\/\" title=\"Glossary: Endormissement\" class=\"glossaryLink\">endormissement<\/a>,<\/li>\n<li>Hypnotique &agrave; demi vie plus longue (moyenne) si plainte d&rsquo;insomnie de maintien ou avec r&eacute;veil matinal pr&eacute;coce.<\/li>\n<\/ul>\n\n<div class=\"wp-block-image\">\n<figure class=\"aligncenter size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"480\" height=\"552\" src=\"https:\/\/sfrms-app.fr\/wp-content\/uploads\/2021\/11\/Capture-27.png\" alt=\"\" class=\"wp-image-1364\" srcset=\"https:\/\/sfrms-app.fr\/wp-content\/uploads\/2021\/11\/Capture-27.png 480w, https:\/\/sfrms-app.fr\/wp-content\/uploads\/2021\/11\/Capture-27-261x300.png 261w\" sizes=\"auto, (max-width: 480px) 100vw, 480px\"\/><\/figure>\n<\/div>\n\n\n<h2 class=\"wp-block-heading\">Contre-indications<\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Insuffisance respiratoire s&eacute;v&egrave;re,<\/li>\n\n\n\n<li>Insuffisance h&eacute;patique s&eacute;v&egrave;re,<\/li>\n\n\n\n<li>SAHOS d&rsquo;intensit&eacute; moyenne &agrave; s&eacute;v&egrave;re non trait&eacute; (IAH &gt; 15\/h),<\/li>\n\n\n\n<li>Myasth&eacute;nie.<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">Bilan pr&eacute; th&eacute;rapeutique<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Rechercher insuffisance h&eacute;patique ou respiratoire s&eacute;v&egrave;re, SAHOS non trait&eacute;, myasth&eacute;nie.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">R&egrave;gles de prescription<\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Prescription limit&eacute;e &agrave; <strong>4 semaines<\/strong>.<\/li>\n\n\n\n<li>Associ&eacute;e aux r&egrave;gles d&rsquo;hygi&egrave;ne de sommeil (cf. Fiche : <a href=\"https:\/\/sfrms-app.fr\/index.php\/2021\/11\/28\/hygiene-du-sommeil\/\"><strong>Hygi&egrave;ne du sommeil<\/strong><\/a>) et interventions comportementales de l&rsquo;insomnie (cf. Fiche : <a href=\"https:\/\/sfrms-app.fr\/index.php\/2021\/11\/28\/therapie-cognitive-et-comportementale-de-linsomnie\/\"><strong>TCC de l&rsquo;insomnie<\/strong><\/a>).<\/li>\n\n\n\n<li>Dose minimale efficace recherch&eacute;e.<\/li>\n\n\n\n<li>&Eacute;viter les associations de 2 benzodiaz&eacute;pines.<\/li>\n\n\n\n<li>Anticipation de l&rsquo;arr&ecirc;t du traitement dans ces 4 semaines.<\/li>\n\n\n\n<li>Information sur les effets ind&eacute;sirables.<\/li>\n\n\n\n<li>Zolpidem: prescription sur ordonnance s&eacute;curis&eacute;e.<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">Surveillance des effets ind&eacute;sirables<\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li>&Agrave; court terme : <strong>Insomnie de rebond<\/strong> (si arr&ecirc;t trop brutal), <strong>hypersomnolence r&eacute;siduelle<\/strong> et risque accidentel (hypnotique &agrave; demi vie moyenne) (cf. Fiche : <a href=\"https:\/\/sfrms-app.fr\/index.php\/2021\/12\/01\/conduite-automobile-et-medecine-du-sommeil\/\"><strong>Conduite automobile<\/strong><\/a>), plaintes mn&eacute;siques, chutes (essentiellement chez le sujet &acirc;g&eacute;).<\/li>\n\n\n\n<li>&Agrave; long terme : <strong><a href=\"https:\/\/sfrms-app.fr\/index.php\/glossary\/dependance\/\" title=\"Glossary: D&eacute;pendance\" class=\"glossaryLink\">D&eacute;pendance<\/a><\/strong> (cf. Fiche : <a href=\"https:\/\/sfrms-app.fr\/index.php\/2021\/11\/27\/echelle-de-dependance-aux-benzodiazepines\/\"><strong>&Eacute;chelle de d&eacute;pendance aux benzodiaz&eacute;pines<\/strong><\/a>), maintien du trouble insomnie chronique.<\/li>\n<\/ul>\n\n\n<div class=\"wp-block-image\">\n<figure class=\"aligncenter size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"544\" height=\"392\" src=\"https:\/\/sfrms-app.fr\/wp-content\/uploads\/2021\/11\/image7.png\" alt=\"\" class=\"wp-image-3972\" srcset=\"https:\/\/sfrms-app.fr\/wp-content\/uploads\/2021\/11\/image7.png 544w, https:\/\/sfrms-app.fr\/wp-content\/uploads\/2021\/11\/image7-300x216.png 300w\" sizes=\"auto, (max-width: 544px) 100vw, 544px\"\/><\/figure>\n<\/div>\n\n<div class=\"wp-block-image\">\n<figure class=\"aligncenter size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"329\" height=\"515\" src=\"https:\/\/sfrms-app.fr\/wp-content\/uploads\/2022\/03\/image8-edited.png\" alt=\"\" class=\"wp-image-3974\" srcset=\"https:\/\/sfrms-app.fr\/wp-content\/uploads\/2022\/03\/image8-edited.png 329w, https:\/\/sfrms-app.fr\/wp-content\/uploads\/2022\/03\/image8-edited-192x300.png 192w\" sizes=\"auto, (max-width: 329px) 100vw, 329px\"\/><\/figure>\n<\/div>\n\n\n<h2 class=\"wp-block-heading\">Suivi d&rsquo;efficacit&eacute;<\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Efficacit&eacute; clinique : plainte d&rsquo;insomnie (cf. Fiches : <strong><a href=\"https:\/\/sfrms-app.fr\/index.php\/2021\/11\/27\/echelle-de-severite-de-linsomnie\/\">&Eacute;chelle de s&eacute;v&eacute;rit&eacute; de l&rsquo;insomnie<\/a> &amp; <a href=\"https:\/\/sfrms-app.fr\/index.php\/2021\/11\/27\/agenda-du-sommeil\/\">Agenda du sommeil<\/a><\/strong>).<\/li>\n\n\n\n<li>Mise en place des r&egrave;gles d&rsquo;hygi&egrave;ne de sommeil (cf. Fiche : <a href=\"https:\/\/sfrms-app.fr\/index.php\/2021\/11\/28\/hygiene-du-sommeil\/\"><strong>Hygi&egrave;ne du sommeil<\/strong><\/a>) et comportementales de l&rsquo;insomnie (cf. Fiche : <a href=\"https:\/\/sfrms-app.fr\/index.php\/2021\/11\/28\/therapie-cognitive-et-comportementale-de-linsomnie\/\"><strong>TCC de l&rsquo;insomnie<\/strong><\/a>).<\/li>\n<\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">Hypnotiques peu utilis&eacute;s<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Il existe deux autres classes pharmaceutiques ayant l&rsquo;indication d&rsquo;autorisation de mise sur le march&eacute; dans l&rsquo;insomnie, mais dont l&rsquo;efficacit&eacute; hypnotique est moins av&eacute;r&eacute;e :<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Les antihistaminiques<\/strong><br>&mdash; Doxylamine &ndash; DONORMYL&reg; et Hydroxyzine &ndash; ATARAX&reg; (attention aux effets anticholinergiques),<br>&mdash; Alim&eacute;mazine &ndash; TH&Eacute;RAL&Egrave;NE&reg; (poss&egrave;de des propri&eacute;t&eacute;s neuroleptiques, attention aux effets extrapyramidaux).<\/li>\n\n\n\n<li><strong>La m&eacute;latonine<\/strong> (cf. Fiche : <a href=\"https:\/\/sfrms-app.fr\/index.php\/2021\/11\/29\/melatonine\/\"><strong>M&eacute;latonine<\/strong><\/a>)<br>&mdash; M&eacute;latonine &agrave; lib&eacute;ration imm&eacute;diate (LI): Pr&eacute;paration magistrale,<br>&mdash; M&eacute;latonine &agrave; lib&eacute;ration prolong&eacute;e (LP): CIRCADIN&reg;.<\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p>Mode d&rsquo;action Les traitements hypnotiques sont des traitements psychotropes ayant comme caract&eacute;ristique essentielle d&rsquo;induire le sommeil. Il s&rsquo;agit de traitement dont la voie d&rsquo;administration est essentiellement orale. Les principales classes d&rsquo;hypnotiques utilis&eacute;es sont: Les hypnotiques de type benzodiaz&eacute;piniques avec notamment: [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":4061,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[12,28],"tags":[],"class_list":["post-1362","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-traitement","category-traitements-du-troubles-insomnie-chronique"],"featured_image_src":"https:\/\/sfrms-app.fr\/wp-content\/uploads\/2021\/11\/UTwTq5an_normal.png","blog_images":{"medium":"https:\/\/sfrms-app.fr\/wp-content\/uploads\/2021\/11\/UTwTq5an_normal.png","large":"https:\/\/sfrms-app.fr\/wp-content\/uploads\/2021\/11\/UTwTq5an_normal.png"},"_links":{"self":[{"href":"https:\/\/sfrms-app.fr\/index.php\/wp-json\/wp\/v2\/posts\/1362","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/sfrms-app.fr\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/sfrms-app.fr\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/sfrms-app.fr\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/sfrms-app.fr\/index.php\/wp-json\/wp\/v2\/comments?post=1362"}],"version-history":[{"count":9,"href":"https:\/\/sfrms-app.fr\/index.php\/wp-json\/wp\/v2\/posts\/1362\/revisions"}],"predecessor-version":[{"id":4773,"href":"https:\/\/sfrms-app.fr\/index.php\/wp-json\/wp\/v2\/posts\/1362\/revisions\/4773"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/sfrms-app.fr\/index.php\/wp-json\/wp\/v2\/media\/4061"}],"wp:attachment":[{"href":"https:\/\/sfrms-app.fr\/index.php\/wp-json\/wp\/v2\/media?parent=1362"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/sfrms-app.fr\/index.php\/wp-json\/wp\/v2\/categories?post=1362"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/sfrms-app.fr\/index.php\/wp-json\/wp\/v2\/tags?post=1362"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}