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[[File:Stilnoct2.JPG|thumb|Ambien (Zolpidem) sleeping pills]]
{{Infobox drug class
A '''sleeping pill''' (people also call it '''sedative''') is a [[drug]] that people take to help them sleep. It calms them, and makes them very relaxed.
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There are different kinds of sedatives:
A '''sedative''' or '''tranquilliser'''{{notetag|Also spelled ''tranquillizer'' ([[Oxford spelling]]) and ''tranquilizer'' (US spelling); see [[American and British English spelling differences|spelling differences]]}} is a substance that induces [[sedation]] by reducing [[irritability]]<ref name="urlJohns Hopkins Colon Cancer Center - Glossary S">{{cite web |url=http://www.hopkinscoloncancercenter.org/index.cfm?cID=194&CFID=1128737&CFTOKEN=20842936 |title=Johns Hopkins Colon Cancer Center - Glossary S }}</ref> or [[Psychomotor agitation|excitement]].<ref>{{DorlandsDict|seven/000095557|sedative}}</ref> They are [[Central nervous system|CNS]] depressants and interact with brain activity causing its deceleration. Various kinds of sedatives can be distinguished, but the majority of them affect the [[neurotransmitter]] [[Gamma-Aminobutyric acid|gamma-aminobutyric acid]] (GABA). In spite of the fact that each sedative acts in its own way, most produce relaxing effects by increasing GABA activity.<ref>{{Cite web|url=https://www.psychologytoday.com/conditions/sedatives|title=Sedatives {{!}} Psychology Today|website=Psychology Today|language=en|access-date=2017-11-20}}</ref>
*Pills that help people fall asleep.
*Pills that help people keep sleeping (not to wake up during the night).
*Pills that calm people down, without making them sleep.


Some sedatives can act very fast, usually in 10-15 minutes. Those who consider taking sedatives should talk with their [[Medical doctor|doctor]], who can give them the sedatives which are best for them.
This group is related to '''[[hypnotic]]s'''. The term ''sedative'' describes drugs that serve to calm or [[Anxiolytic|relieve anxiety]], whereas the term ''hypnotic'' describes drugs whose main purpose is to initiate, sustain, or lengthen sleep. Because these two functions frequently overlap, and because drugs in this class generally produce dose-dependent effects (ranging from [[anxiolysis]] to loss of consciousness) they are often referred to collectively as '''sedative-hypnotic''' drugs.<ref name="Pharmacologic Basis of Therapeutics">{{cite book|last1=Brunton |first1=Laurence L. |last2=Lazo |first2=John S. |last3=Lazo Parker |first3=Keith L. |title=Goodman & Gilman's The Pharmacological Basis of Therapeutics |publisher=The McGraw-Hill Companies, Inc. |year=2006 |edition=11th |chapter-url=http://accessmedicine.mhmedical.com/content.aspx?bookid=374&sectionid=41266223 |chapter=17: Hypnotics and Sedatives |isbn=978-0-07-146804-6 |access-date=2014-02-06}}</ref>


Most sedatives are highly [[addiction|addictive]], so people need a [[prescription]] from their doctor to get sedatives.
Sedatives can be misused to produce an overly-calming effect ([[alcohol (drug)|alcohol]] being the classic and most common sedating drug). In the event of an overdose or if combined with another sedative, many of these drugs can cause deep [[unconsciousness]] and even [[death]].
If they take sleeping pills for a longer time, they can get addicted. Getting rid of the addiction is very hard to do.  Addiction means that people who take the drug cannot stop taking it, without bad consequences (as described below). It's like people who want to stop smoking, but who cannot.


People who have taken sedatives may seem dull, and sleepy. Since sleeping pills act on their ability to react, those who have taken such pills should not do the following:
==Terminology==
*Operate any machines
There is some overlap between the terms "sedative" and "[[hypnotic]]".
*Drive a car
*Drink alcohol (This may make the effect of the pill bigger.)


Some people are addicted to sedatives. When they stop taking the sedatives, they may experience the following
Advances in pharmacology have permitted more specific targeting of receptors, and greater selectivity of agents, which necessitates greater precision when describing these agents and their effects:
*[[Insomnia]] (being unable to sleep)
*Restlessness
*[[Anxiety]] (feeling fear)
*Convulsions and [[seizure]]s


Some addictions can also be psychological; when the users stop taking the drug, they may feel [[depression (illness)|depressed]].
* [[Anxiolytic]] refers specifically to the effect upon [[anxiety]]. (However, some benzodiazepines can be all three: sedatives, hypnotics, and anxiolytics).
* [[Tranquilizer]] can refer to anxiolytics or [[antipsychotic]]s.
* [[Soporific]] and sleeping pill are near-synonyms for [[hypnotic]]s.


[[Category:Drugs]]
=== The term "chemical cosh" ===
The term "chemical [[club (weapon)|cosh]]" (a club) is sometimes used popularly for a strong sedative, particularly for:
* widespread dispensation of [[antipsychotic|antipsychotic drugs]] in residential care to make people with [[dementia]] easier to manage.<ref>{{cite news|url=https://www.telegraph.co.uk/health/elderhealth/8086614/Chemical-cosh-will-be-cut-for-dementia-sufferers.html|title='Chemical cosh' will be cut for dementia sufferers|date=25 October 2010|work=Telegraph.co.uk|access-date=12 September 2015|last1=Smith|first1=Rebecca}}</ref>
* use of [[methylphenidate]] to calm children with [[attention deficit hyperactivity disorder]], though paradoxically this drug is known to be a stimulant.
** See also [[Antipsychotic#Controversy|Antipsychotic controversy]]


[[ja:精神安定剤]]
===Types of sedatives===
{{Unreferenced section|date=April 2009}}
{{columns-list|colwidth=22em|
* [[Barbiturate]]s
** [[Benzylbutylbarbiturate]]
** [[Butalbital]]
** [[Amobarbital]]
** [[Pentobarbital]]
** [[Secobarbital]]
** [[Sodium thiopental]]
** [[Phenobarbital]]
* [[Benzodiazepine]]s
** [[Clonazepam]]
** [[Diazepam]]
** [[Estazolam]]
** [[Flunitrazepam]]
** [[Lorazepam]]
** [[Midazolam]]
** [[Nitrazepam]]
** [[Oxazepam]]
** [[Triazolam]]
** [[Temazepam]]
** [[Chlordiazepoxide]]
** [[Alprazolam]]
** [[Clobazam]]
** [[Clorazepate]]
** [[Etizolam]]
* [[Nonbenzodiazepine]] [[hypnotics]]
** [[Eszopiclone]]
** [[Zaleplon]]
** [[Zolpidem]]
** [[Zopiclone]]
* [[Orexin antagonists]]
** [[Suvorexant]]
* [[Antihistamine|First generation Antihistamines]]
** [[Diphenhydramine]]
** [[Dimenhydrinate]]
** [[Doxylamine]]
** [[Promethazine]]
** [[Hydroxyzine]]
** [[Brompheniramine]]
** [[Chlorpheniramine]]
* General [[Anesthetics]]
** [[Nitrous oxide]]
** [[Sevoflurane]]
** [[Halothane]]
** [[Xenon]]
** [[Enflurane]]
** [[Chloroform]]
** [[Isoflurane]]
** [[Methoxyflurane]]
** [[Desflurane]]
** [[Ethyl chloride]]
** [[Cyclopropane]]
** [[Chloral hydrate]]
** [[Ketamine]]
** [[Esketamine]]
** [[Etomidate]]
** [[Propofol]]
** [[Chlorobutanol]]
* Herbal sedatives
** [[Duboisia hopwoodii]]
** [[Chamomile]]
** [[Prostanthera|Prostanthera striatiflora]]
** [[Nepeta|catnip]]
** [[Kava]] (Piper methysticum)
** [[Valerian (herb)|valerian]]
** [[Cannabis (herb)|cannabis]]
** [[Maypop|Passiflora spp.(passiflora incarnata)]]
** [[Physochlaina]] - notably P. infundibularis
** [[Validol]]
* Methaqualone and analogues
** [[Afloqualone]]
** [[Cloroqualone]]
** [[Diproqualone]]
** [[Etaqualone]]
** [[Methaqualone]]
** [[Methylmethaqualone]]
** [[Mebroqualone]]
** [[Mecloqualone]]
** [[Nitromethaqualone]]
* Skeletal [[Muscle Relaxants]]
** [[Baclofen]]
** [[Meprobamate]]
** [[Carisoprodol]]
** [[Cyclobenzaprine]]
** [[Metaxalone]]
** [[Methocarbamol]]
** [[Tizanidine]]
** [[Clonidine]]
** [[Chlorzoxazone]]
** [[Orphenadrine]]
** [[Gabapentin]]
** [[Pregabalin]]
* [[Opioids]]
** [[Tramadol]]
** [[Tapentadol]]
** [[Morphine]]
** [[Diamorphine]]
** [[Hydromorphone]]
** [[Oxymorphone]]
** [[Oxycodone]]
** [[Hydrocodone]]
** [[Methadone]]
** [[Propoxyphene]]
** [[Meperidine]]
** [[Fentanyl]]
** [[Codeine]]
** [[Carfentanil]]
** [[Remifentanil]]
** [[Alfentanil]]
** [[Sufentanil]]
** [[Opium]]
* [[Antidepressant]]s
** [[Amitriptyline]]
** [[Trazodone]]
** [[Mirtazapine]]
** [[Doxepin]]
** [[Desipramine]]
** [[Imipramine]]
** [[Clomipramine]]
** [[Amoxapine]]
** [[Trimipramine]]
** [[Nortriptyline]]
** [[Nefazodone]]
* [[Antipsychotic]]s
** [[Olanzapine]]
** [[Clozapine]]
** [[Thiothixene]]
** [[Haloperidol]]
** [[Fluphenazine]]
** [[Prochlorperazine]]
** [[Trifluoperazine]]
** [[Loxapine]]
** [[Quetiapine]]
** [[Asenapine]]
* Other
** [[2-methyl-2-butanol]] (2M2B)
** [[Ethanol]]
** [[Glutethimide]]
** [[Gamma-Hydroxybutyric acid|GHB]]
** [[Dextromethorphan]]
** [[Dexmedetomidine]]}}
 
==Therapeutic use==
[[Physician|Doctor]]s often administer sedatives to patients in order to dull the patient's anxiety related to painful or anxiety-provoking procedures. Although sedatives do not relieve pain in themselves, they can be a useful adjunct to [[analgesic]]s in preparing patients for [[surgery]], and are commonly given to patients before they are [[anaesthesia|anaesthetized]], or before other highly uncomfortable and  invasive procedures like [[cardiac catheterization]], [[colonoscopy]] or [[MRI]].
 
== Risks ==
 
===Sedative dependence===
Some sedatives can cause psychological and physical dependence when taken regularly over a period of time, even at therapeutic doses.<ref>{{cite journal | vauthors = Yi PL, Tsai CH, Chen YC, Chang FC | title = Gamma-aminobutyric acid (GABA) receptor mediates suanzaorentang, a traditional Chinese herb remedy, -induced sleep alteration | journal = Journal of Biomedical Science | volume = 14 | issue = 2 | pages = 285–97 | date = March 2007 | pmid = 17151826 | doi = 10.1007/s11373-006-9137-z }}</ref><ref>{{cite journal | vauthors = Ebert B, Wafford KA, Deacon S | title = Treating insomnia: Current and investigational pharmacological approaches | journal = Pharmacology & Therapeutics | volume = 112 | issue = 3 | pages = 612–29 | date = December 2006 | pmid = 16876255 | doi = 10.1016/j.pharmthera.2005.04.014 }}</ref><ref>{{cite journal | vauthors = Sarrecchia C, Sordillo P, Conte G, Rocchi G | title = [Barbiturate withdrawal syndrome: a case associated with the abuse of a headache medication] | language = it | journal = Annali Italiani di Medicina Interna | volume = 13 | issue = 4 | pages = 237–9 | year = 1998 | pmid = 10349206 }}</ref><ref>{{cite journal | vauthors = Proudfoot H, Teesson M | title = Who seeks treatment for alcohol dependence? Findings from the Australian National Survey of Mental Health and Wellbeing | journal = Social Psychiatry and Psychiatric Epidemiology | volume = 37 | issue = 10 | pages = 451–6 | date = October 2002 | pmid = 12242622 | doi = 10.1007/s00127-002-0576-1 }}</ref> Dependent users may get withdrawal symptoms ranging from restlessness and insomnia to convulsions and death. When users become psychologically dependent, they feel as if they need the drug to function, although physical dependence does not necessarily occur, particularly with a short course of use. In both types of dependences, finding and using the sedative becomes the focus in life.  Both physical and psychological dependence can be treated with therapy.
 
===Misuse===
{{Main article|Drug overdose}}
{{Further|Combined drug intoxication}}
{{See also|Benzodiazepine overdose|Barbiturate overdose}}
 
Many sedatives can be misused, but barbiturates and benzodiazepines are responsible for most of the problems with sedative use due to their widespread recreational or non-medical use. People who have difficulty dealing with stress, anxiety or sleeplessness may overuse or become dependent on sedatives. Some [[heroin]] users may take them either to supplement their drug or to substitute for it. [[Stimulant]] users may take sedatives to calm excessive jitteriness. Others take sedatives recreationally to relax and forget their worries. Barbiturate overdose is a factor in nearly one-third of all reported drug-related deaths. These include [[suicide]]s and accidental drug poisonings. Accidental deaths sometimes occur when a drowsy, confused user repeats doses, or when sedatives are taken with [[Alcoholic beverages|alcohol]].
 
A study from the United States found that in 2011, sedatives and hypnotics were a leading source of adverse drug events (ADEs) seen in the hospital setting: Approximately 2.8% of all ADEs present on admission and 4.4% of ADEs that originated during a hospital stay were caused by a sedative or hypnotic drug.<ref>Weiss AJ, Elixhauser A. Origin of Adverse Drug Events in U.S. Hospitals, 2011. HCUP Statistical Brief #158. Agency for Healthcare Research and Quality, Rockville, MD. July 2013. [http://hcup-us.ahrq.gov/reports/statbriefs/sb158.jsp]</ref>  A second study noted that a total of 70,982 sedative exposures were reported to U.S. [[poison]] control centers in 1998, of which 2310 (3.2%) resulted in major [[toxicity]] and 89 (0.1%) resulted in death.  About half of all the people admitted to emergency rooms in the U.S. as a result of nonmedical use of sedatives have a legitimate prescription for the drug, but have taken an excessive dose or combined it with alcohol or other drugs.<ref>{{Cite web | url = http://emedicine.medscape.com/article/818430-overview | title = Toxicity, Sedatives | access-date = 18 December 2008 | author = Professor Jeffrey S Cooper | date = 10 December 2007 | publisher = eemedicine | location = USA}}</ref>
 
There are also serious [[paradoxical reactions]] that may occur in conjunction with the use of sedatives that lead to unexpected results in some individuals.  Malcolm Lader at the Institute of Psychiatry in London estimates the incidence of these adverse reactions at about 5%, even in short-term use of the drugs.  The paradoxical reactions may consist of [[depression (mood)|depression]], with or without suicidal tendencies, [[phobias]], aggressiveness, [[violent]] behavior and symptoms sometimes misdiagnosed as [[psychosis]].<ref>{{cite web|url=http://www.benzo.org.uk/paradox.htm|title=benzo.org.uk - Benzodiazepines: Paradoxical Reactions and Long-Term Side-Effects|access-date=12 September 2015}}</ref>
 
===Dangers of combining sedatives and alcohol===
{{Further|Combined Drug Intoxication}}
Sedatives and alcohol are sometimes combined recreationally or carelessly. Since alcohol is a strong  depressant that slows [[brain]] function and depresses respiration, the two substances compound each other's actions and this combination can prove fatal.
 
=== Worsening of psychiatric symptoms ===
The long-term use of benzodiazepines may have a similar effect on the brain as [[Alcoholic beverage|alcohol]], and are also implicated in [[Mood disorder#Substance-induced|depression]], [[Anxiety#Substance-induced|anxiety]], posttraumatic stress disorder (PTSD), mania, psychosis, [[Insomnia#Substance-induced Sleep Disorder|sleep disorders]], sexual dysfunction, delirium, and neurocognitive disorders (including benzodiazepine-induced persisting dementia which persists even after the medications are stopped).<ref name=":12">{{Cite book|title = Diagnostic and statistical manual of mental disorders, fifth edition|last = American Psychiatric Association|publisher = American Psychiatric Association|year = 2013|location = Arlington, VA}}</ref> As with alcohol, the effects of benzodiazepine on neurochemistry, such as decreased levels of [[serotonin]] and [[norepinephrine]], are believed to be responsible for their effects on mood and anxiety.<ref>{{cite book |last1 = Collier|first1 = Judith|last2 = Longmore|first2 = Murray|editor1-first = Peter|editor1-last = Scally|title = Oxford Handbook of Clinical Specialties|edition = 6|year = 2003|publisher = Oxford University Press|isbn = 978-0-19-852518-9|page = 366|chapter = 4}}</ref><ref name="ashman">{{cite web |author = Professor Heather Ashton|year = 2002|url = http://www.benzo.org.uk/manual/bzcha03.htm|title = Benzodiazepines: How They Work and How to Withdraw}}</ref><ref>{{cite journal | vauthors = Lydiard RB, Laraia MT, Ballenger JC, Howell EF | title = Emergence of depressive symptoms in patients receiving alprazolam for panic disorder | journal = The American Journal of Psychiatry | volume = 144 | issue = 5 | pages = 664–5 | date = May 1987 | pmid = 3578580 | doi = 10.1176/ajp.144.5.664 }}</ref><ref>{{cite journal | vauthors = Nathan RG, Robinson D, Cherek DR, Davison S, Sebastian S, Hack M | title = Long-term benzodiazepine use and depression | journal = The American Journal of Psychiatry | volume = 142 | issue = 1 | pages = 144–5 | date = January 1985 | pmid = 2857068 | doi = 10.1176/ajp.142.1.144-b | publisher = American Journal of Psychiatry }}</ref><ref>{{cite journal | vauthors = Longo LP, Johnson B | title = Addiction: Part I. Benzodiazepines--side effects, abuse risk and alternatives | journal = American Family Physician | volume = 61 | issue = 7 | pages = 2121–8 | date = April 2000 | pmid = 10779253 }}</ref><ref>{{Cite book|title = Psychiatry, third edition|vauthors= Tasman A, Kay J, Lieberman JA |publisher = John Wiley & Sons|year = 2008|location = Chichester, England|pages = 2603–2615}}</ref> Additionally, benzodiazepines can indirectly cause or worsen other psychiatric symptoms (e.g., mood, anxiety, psychosis, irritability) by worsening sleep (i.e., benzodiazepine-induced sleep disorder). [[Sleep induction#Alcohol|Like alcohol]], [[benzodiazepine]]s are commonly used to treat insomnia in the short-term (both prescribed and self-medicated), but worsen sleep in the long-term. While benzodiazepines can put people to sleep but, while asleep, the drugs disrupt [[sleep architecture]]: decreasing sleep time, delaying time to REM sleep, and decreasing deep [[slow-wave sleep]] (the most restorative part of sleep for both energy and mood).<ref>{{cite journal | vauthors = Ashton H | title = The diagnosis and management of benzodiazepine dependence | journal = Current Opinion in Psychiatry | volume = 18 | issue = 3 | pages = 249–55 | date = May 2005 | pmid = 16639148 | doi = 10.1097/01.yco.0000165594.60434.84 | url = https://semanticscholar.org/paper/1ac3f26c56ba4697cfa222afaacf3b832311d89a }}</ref><ref>{{cite journal | vauthors = Morin CM, Bélanger L, Bastien C, Vallières A | title = Long-term outcome after discontinuation of benzodiazepines for insomnia: a survival analysis of relapse | journal = Behaviour Research and Therapy | volume = 43 | issue = 1 | pages = 1–14 | date = January 2005 | pmid = 15531349 | doi = 10.1016/j.brat.2003.12.002 }}</ref><ref>{{cite journal | vauthors = Poyares D, Guilleminault C, Ohayon MM, Tufik S | title = Chronic benzodiazepine usage and withdrawal in insomnia patients | journal = Journal of Psychiatric Research | volume = 38 | issue = 3 | pages = 327–34 | date = 2004-06-01 | pmid = 15003439 | doi = 10.1016/j.jpsychires.2003.10.003 }}</ref>
 
=== Dementia ===
Sedatives and hypnotics should be avoided in people with dementia,<ref>{{cite journal | vauthors = Lee J | title = Use of sedative-hypnotics and the risk of Alzheimer’s dementia: A retrospective cohort study | publisher = PLOS ONE | date=September 2018 | url = https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0204413 | doi = 10.1371/journal.pone.0204413 | access-date = 10 Oct 2020 | doi-access = free }}</ref> according to the [[medication appropriateness tool for co‐morbid health conditions in dementia criteria]].<ref>{{cite journal | vauthors = Page AT, Potter K, Clifford R, McLachlan AJ, Etherton-Beer C | title = Medication appropriateness tool for co-morbid health conditions in dementia: consensus recommendations from a multidisciplinary expert panel | journal = Internal Medicine Journal | volume = 46 | issue = 10 | pages = 1189–1197 | date = October 2016 | pmid = 27527376 | pmc = 5129475 | doi = 10.1111/imj.13215 }}</ref> The use of these medications can further impede cognitive function for people with dementia, who are also more sensitive to side effects of medications.
 
===Amnesia===
Sedatives can sometimes leave the patient with long-term or short-term [[amnesia]].
[[Lorazepam]] is one such pharmacological agent that can cause [[anterograde amnesia]].  [[Intensive care unit]] patients who receive higher doses over longer periods, typically via [[Intravenous therapy|IV drip]], are more likely to experience such side effects.
Additionally, the prolonged use of tranquilizers increases the risk of obsessive and compulsive disorder, where the person becomes unaware whether he has performed a scheduled activity or not, he may also repetitively perform tasks and still re-performs the same task trying to make-up for coutinous doubts. Remembering names that were earlier known becomes an issue such that the memory loss becomes apparent.
 
===Disinhibition and crime===
Sedatives — most commonly  [[ethylalcohol|alcohol]]<ref>{{cite journal | vauthors = Weir E | title = Drug-facilitated date rape | journal = CMAJ | volume = 165 | issue = 1 | pages = 80 | date = July 2001 | pmid = 11468961 | pmc = 81265 | url = http://www.cmaj.ca/cgi/content/full/165/1/80 }}</ref> but also [[Gamma-hydroxybutyrate|GHB]], [[Flunitrazepam]] (Rohypnol), and to a lesser extent, [[temazepam]] (Restoril), and [[midazolam]] (Versed)<ref>{{cite journal | vauthors = Negrusz A, Gaensslen RE | title = Analytical developments in toxicological investigation of drug-facilitated sexual assault | journal = Analytical and Bioanalytical Chemistry | volume = 376 | issue = 8 | pages = 1192–7 | date = August 2003 | pmid = 12682705 | doi = 10.1007/s00216-003-1896-z }}</ref> — have been reported for their use as [[date rape]] drugs (also called a [[Mickey Finn (drugs)|Mickey]]) and being administered to unsuspecting patrons in bars or guests at parties to reduce the intended victims' defenses. These drugs are also used for [[Robbery|robbing]] people.
 
Statistical overviews suggest that the use of sedative-spiked drinks for robbing people is actually much more common than their use for rape.<ref>{{cite news|first=Tony|last=Thompson|url=http://observer.guardian.co.uk/uk_news/story/0,,1376917,00.html|title='Rape drug' used to rob thousands|publisher=[[The Observer]]|date=19 December 2004|access-date=2008-05-08}}</ref> Cases of criminals taking rohypnol themselves before they commit crimes have also been reported{{Citation needed|date=March 2011}}, as the loss of inhibitions from the drug may increase their confidence to commit the offence, and the [[amnesia]] produced by the drug makes it difficult for police to interrogate them if they are caught.
 
== See also ==
* [[Hypnotic]]
* [[Antidepressants]]
* [[Benzodiazepine withdrawal syndrome]]
* [[Tranquilizer]]
* [[Tranquilizer gun]]
* [[Diphenhydramine citrate]]
 
==Notes==
{{notefoot}}
 
== References ==
{{Reflist|2}}
 
== Further reading ==
* Tone, Andrea. ''The Age of Anxiety: A History of America's Turbulent Affair with Tranquilizers'' (Basic Books, 2009) 288 pp.; {{ISBN|978-0-465-08658-0}} [https://www.amazon.com/Age-Anxiety-Americas-Turbulent-Tranquilizers/dp/B002ECEUX0/ excerpty and text search]
 
{{Major drug groups}}
{{Hypnotics and sedatives}}
 
[[Category:Sedatives| ]]
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