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28-NIGHT INSQtv1NIA RELIEF.:.PKOVED BY THE POLYGRAPH,CORROBORATED BY THE PATIENTS2
One ](>orne capsule h.s. - usual adult doUIpU5 mg may suffice in some patients).One 15-me capsule h.s. recommetlded doupfor ekIerIy or debllltMed p8tIents.
Before presc:ribinc Dall11lne (flurazepam Hel), please consultco~eproduct information, a summary 01 which follows:Indications: Effective in all types of insomnia characterized bydifficulty in falling asleep, frequent nocturnal awakenings and/orearly morning awakening; in patients with recurring insomnia orpoor sleeping habits; in acute or chronic medical situations requiri ng restful sleep. Objective sleep laboratory data have showneffectiveness for at least 28 consecutive nights of administration.Since insomnia is often transient and intermittent, prolongedadministration is generally not necessary or recommended.Contraindications: Known hypersensitivity to flurazepam HCI.Wtminp: Caution patients about possible combined effects withalcohol and other CNS depressants. Caution against hazardousoccupations requiring complete mental alertness (e.g., operatingmachinery, driving).
Us8ge in Pregnancy:Several studies01 minortranquilizers(chlord~xide,diazeP.am,andmeprobamate)suaestincreased nsk 01 concenital malfonnationsdurincthe firsttrimester 01 prepancy. Dalmane, a benzodiazepine, hasnot been studiedadeq~to determine whether it maybe associated with such an Increased risk. Because use01 these drugs is rarely a matter 01 urgency, their usedurinc this period should almost always be avoided. C0nsider possibility 01 pregnancy when institutinc therapy;advise patients to discuss therapy if they intend to ordo become prepant.
Not recommended for use in persons under 15 years of age.Though physical and psychological dependence have not beenreported on recommended doses, use caution in administering toaddiction-prone individuals or those who might increase dosage.Precautions: In elderly and debilitated, limit dosage to 15 mgto reduce risk of oversedation, dizziness, confusion and/or ataxia.Consider potential additive effects with other hypnotics or CNSdepressants. Employ usual precautions in patients who are severely depressed, or with latent depression or suicidal tendencies,or with impaired renal or hepatic function. Periodic bloodcounts and liver and kidney function tests are advised duringrepeated therapy.Adverse Reactions: Dizziness, drowsiness, Iightheadedness,staggering, ataxia and falling have occurred, particularly in elderlyor debilitated patients. Severe sedation, lethargy, disorientationand coma, probably indicative of drug intolerance or overdosage,have been reported. Also reported: headache, heartburn, upsetstomaCh, nausea, vomiting, diarrhea, constipation, GI pain, nervousness, talkativeness, apprehension, irritability, weakness,palpitations, chest pains, body and joint pains and GU complaints.There have also been rare occurrences of leukopenia, granulocytopenia, sweating, flushes, difficulty in focusing, blurred vision,burning eyes, faintness, hypotension, shortness of breath,pruritus, skin rash, dry mouth, bitter taste, excessive salivation,anorexia, euphoria, depression, slurred speech, confusion, restlessness, hallucinations, paradoxical reactions, e.g., excitement.stimulation and hyperactivity, and elevated SGOT, SGPT, total anddirect bilirubins and alkaline phosphatase.Dosage: Individualize for maximum beneficial effect.Adults: 30 mg usual dosage; 15 mg may suffice in some patients.Elderly or debilitated patients: 15 mg initially until responseis determined.Supplied: Capsules containing 15 mg or 30 mg flurazepam HCI.
REFERENCES:1. Kales A, et al: Clin Pharmacol Ther 19:576-583, May 19762. Dement WC, Guilleminault C, Zarcone V: Progress in clinicalsleep research. Scientific exhibit at the American MedicalAssociation, Atlantic City NJ, Jun 14-18, 1975
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BOOKREVIEWSControversy in PsychiatryEdited by John Paul Brady and H. Keith H.Brodie, 1087 pp, $39.50, Philadelphia,Saunders, 1978.
• It was time for a book like this tobe published, for controversy inand about psychiatry abounds.Questions have been asked for thelast decade as to whether or notpsychiatry should exist and what itsfunction is. Some psychiatrists havebeen told by other mental healthworkers that they knew as much asthe .psychiatrists and the latter'sonly function was to sign prescriptions. Psychologists say that psychiatrists practice psychology, forwhich they are not trained, and donot practice medicine, for whichthey are trained. Obviously, a booklike this that examines variousphases of this controversy isneeded.
The editors chose 26 topics thatneeded to be aired and had themdiscussed, pro and con, by knowledgeable individuals, with the twoeditors appending a comment toeach chapter. Incidentally, the 26topics cover most of the problemsthat agitate the specialty today, andthe editors were fortunate to beable to attract such a high caliber of
In the November 1978 issue ofPsychosomatics, Figure 2 in the article "Ventricular premature beats,stress, and sudden death" was reproduced with permission fromDeSilva RA, Verrier RL, and LownB, Am Heart J 95:197, 1978. Theeditors regret this omission.