Pharmacological treatment of insomnia includes prescription drugs, non-prescription medications, and "natural" remedies. Behavioral approaches such as cognitive behavioral therapy, which are not discussed here, are also used. Pharmacologic treatment and behavioral therapy are often combined.
BENZODIAZEPINE RECEPTOR AGONISTS — Zolpidem (Ambien, and others), zaleplon (Sonata, and generics), and eszopiclone (Lunesta, and generics) are not structural benzodiazepines, but they bind to benzodiazepine receptors. All of them decrease sleep latency and are approved for use in patients with sleep-onset insomnia. Benzodiazepine receptor agonists differ mainly in their duration of action (see Table 1).
Zolpidem is the most widely prescribed hypnotic in the US. The FDA has required manufacturers of zolpidem to lower the recommended dose for women and to recommend consideration of a lower dose for men because of concerns about high serum concentrations 8 hours
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The FDA has approved Liletta, an intrauterine device (IUD) that releases the synthetic progestin levonorgestrel, for prevention of pregnancy for up to 3 years. The fourth IUD to be approved in the US, and the third that releases levonorgestrel, Liletta is comarketed by Actavis and Medicines360, a nonprofit women's health pharmaceutical company. The wholesale cost of Liletta is similar to that of other IUDs (see Table 1), but the manufacturer offers programs that significantly reduce the cost for commercially-insured patients and clinics serving low-income women.1
OTHER IUDs — IUDs provide convenient, long-term contraception and a rapid return to fertility after removal. ParaGard T 380A, a copper-containing IUD, Mirena, which contains 52 mg of levonorgestrel, and Skyla, which contains 13.5 mg of levonorgestrel, are FDAapproved for up to 10, 5, and 3 years of use, respectively. Daily drug