Long-term use of sedative-hypnotics for insomnia lacks an evidence base and has traditionally been discouraged for reasons that include concerns about such potential adverse drug effects as cognitive impairment (anterograde amnesia), daytime sedation, motor incoordination, and increased risk of motor vehicle accidents and falls. In addition, the effectiveness and safety of long-term use of these agents remain to be determined. It was concluded that more research is needed to evaluate the long-term effects of treatment and the most appropriate management strategy for elderly persons with chronic insomnia. Pharmacology
Estazolam is classed as a "triazolo" benzodiazepine drug. Estazolam exerts its therapeutic effects via its benzodiazepines receptor agonist properties. Estazolam at high doses decreases histamine turnover via its action at the benzodiazepine-GABA receptor complex in mouse brains. Pharmacokinetics
Peak plasma levels are achieved within 1–6 hours. Estazolam is an intermediate acting benzodiazepine. The elimination half life of estazolam is an average of 19 hours, with a range of 8–31 hours. The major metabolite of estazolam is 4-hydroxyestazolam. Other identified metabolites include 1-oxo-estazolam, 4-hydroxy-estazolam, and benzophenone. Interactions
Alcohol enhances the sedative hypnotic properties of estazolam. In package inserts, the manufacturer clearly warns about an interaction with Ritonavir, and although clinical interactions of Ritonavir with estazolam have not yet been described, the lack of clinical descriptions of the interactions does not negate the seriousness of the interaction.
Palmar erythema is reddening of the palms at the thenar and hypothenar eminences. : 139

Causes
It is associated with various physiological as well as pathological changes, or may be a normal finding:

Portal hypertension
Chronic liver disease (including chronic hepatitis)
Pregnancy
Polycythemia
Thyrotoxicosis
Rheumatoid arthritis (especially in patients with polycythaemia)
Eczema and psoriasis
Deep telangiectasias
Coxsackievirus A infection (Hand, foot and mouth disease)
Rocky Mountain spotted fever
Secondary syphilis
Kawasaki disease
Adverse drug reaction: palmoplantar erythrodysesthesia (acral erythema)Because circulating levels of estrogen increase in both cirrhosis and pregnancy, estrogen was thought to be the main cause for the increased vascularity. More recently, nitric oxide has also been implicated in the pathogenesis of palmar erythema. Diagnosis
Palmar erythema has no specific treatment. Management is based on the  underlying cause. When its cause is treated then patients get relief. If it is attributable to a particular drug then the drug should be withdrawn. See also
Toxic erythema
List of cutaneous conditions

References


== External links ==