ISSUE 1463
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The FDA has approved suvorexant (Belsomra – Merck), the first orexin receptor antagonist to become available in the US, for treatment of sleep-onset and/or sleep-maintenance insomnia.
DRUGS FOR INSOMNIA — Benzodiazepine receptor agonists, benzodiazepines, the melatonin receptor agonist ramelteon (Rozerem, and generics), and low doses of the antidepressant doxepin (Silenor, and generics) are effective and generally safe for treatment of insomnia. Benzodiazepine receptor agonists such as zolpidem (Ambien, and others) are the most widely prescribed hypnotics in the US, but they can impair next-day driving ability, increase the risk of falls in the elderly, and rarely cause anterograde amnesia, hallucinations, and complex sleep-related behaviors that occur without conscious awareness. Over-the-counter antihistamines marketed as "sleep-aids" are also widely used, but they can cause
... more- Drugs for insomnia. Treat Guidel Med Lett 2012; 10:57.
- RA España and TE Scammell. Sleep neurobiology from a clinical perspective. Sleep 2011; 34:845.
- WJ Herring et al. Suvorexant in patients with insomnia: results from two 3-month randomized controlled clinical trials. Biol Psychiatry 2014. Oct 23 (epub).
- WJ Herring et al. Orexin receptor antagonism for treatment of insomnia: a randomized clinical trial of suvorexant. Neurology 2012; 79:2265.
- D Michelson et al. Safety and efficacy of suvorexant during 1-year treatment of insomnia with subsequent abrupt treatment discontinuation: a phase 3 randomised, double-blind, placebo-controlled trial. Lancet Neurol 2014; 13:461.
- Inhibitors and inducers of CYP enzymes and P-glycoprotein. Med Lett Drugs Ther 2013; 55:e44.

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