ISSUE 1472
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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
... more- FDA requires lower dosing of zolpidem. Med Lett Drugs Ther 2013; 55:5.
- FDA Drug Safety Communication: FDA approves new label changes and dosing for zolpidem products and a recommendation to avoid driving the day after using Ambien CR. Available at: www.fda.gov. Accessed June 25, 2015.
- Low-dose sublingual zolpidem (Intermezzo) for insomnia due to middle-of-the-night awakening. Med Lett Drugs Ther 2012; 54:25.
- In brief: lowering the dose of Lunesta. Med Lett Drugs Ther 2014; 56:48.
- RN Hansen et al. Sedative hypnotic medication use and the risk of motor vehicle crash. Am J Public Health 2015 June 11 (epub).
- N Gunja. In the Zzz zone: the effects of Z-drugs on human performance and driving. J Med Toxicol 2013; 9:163.
- N Gunja. The clinical and forensic toxicology of Z-drugs. J Med Toxicol. 2013; 9:155.
- JS Poceta. Zolpidem ingestion, automatisms, and sleep driving: a clinical and legal case series. J Clin Sleep Med 2011; 7:632.
- DF Kripke et al. Hypnotics' association with mortality or cancer: a matched cohort study. BMJ Open 2012; 2:e000850.
- CH Kao et al. Relationship of zolpidem and cancer risk: a Taiwanese population-based cohort study. Mayo Clin Proc 2012; 87:430.
- Inhibitors and inducers of CYP enzymes and P-glycoprotein. Med Lett Drugs Ther 2013; 55:e44.
- MJ Rapoport et al. Benzodiazepine use and driving: a meta-analysis. J Clin Psychiatry 2009; 70:663.
- B Albrecht et al. Benzodiazepine use and aggressive behaviour: a systematic review. Aust N Z J Psychiatry 2014; 48:1096.
- M Jann et al. Benzodiazepines: a major component in unintentional prescription drug overdoses with opioid analgesics. J Pharm Pract 2014; 27:5.
- Ramelteon (Rozerem) for insomnia. Med Lett Drugs Ther 2005; 47:89.
- A Kuriyama et al. Ramelteon for the treatment of insomnia in adults: a systematic review and meta-analysis. Sleep Med 2014; 15:385.
- Low-dose doxepin (Silenor) for insomnia. Med Lett Drugs Ther 2010; 52:79.
- AD Krystal et al. Efficacy and safety of doxepin 3 and 6 mg in a 35-day sleep laboratory trial in adults with chronic primary insomnia. Sleep 2011; 34:1433.
- JM Uslaner et al. Orexin receptor antagonists differ from standard sleep drugs by promoting sleep at doses that do not disrupt cognition. Sci Transl Med 2013; 5:179ra44.
- Suvorexant (Belsomra) for insomnia. Med Lett Drugs Ther 2015; 57:29.
- H Sun et al. Effects of suvorexant, an orexin receptor antagonist, on breathing during sleep in patients with chronic obstructive pulmonary disease. Respir Med 2015; 109:416.
- MH Wiegand. Antidepressants for the treatment of insomnia: a suitable approach? Drugs 2008; 68:2411.
- WB Mendelson. A review of the evidence for the efficacy and safety of trazodone in insomnia. J Clin Psychiatry 2005; 66:469.
- ED Hermes et al. Use of second-generation antipsychotic agents for sleep and sedation: a provider survey. Sleep. 2013; 36:597.
- SL Anderson and JP Vande Griend. Quetiapine for insomnia: a review of the literature. Am J Health Syst Pharm 2014; 71:394.
- CW Bazil. Gabapentin improves sleep in the presence of alcohol. J Clin Sleep Med 2005; 1:284.
- I Hindmarch et al. A double-blind study in healthy volunteers to assess the effects on sleep of pregabalin compared with alprazolam and placebo. Sleep 2005; 28:187.
- C Fox et al. Anticholinergic medication use and cognitive impairment in the older population: the medical research council cognitive function and ageing study. J Am Geriatr Soc 2011; 59:1477.
- AG Wade et al. Nightly treatment of primary insomnia with prolonged release melatonin for 6 months: a randomized placebo controlled trial on age and endogenous melatonin as predictors of efficacy and safety. BMC Med 2010; 8:51.
- DM Taibi et al. A systematic review of valerian as a sleep aid: safe but not effective. Sleep Med Rev 2007; 11:209.
- J Sarris and GJ Byrne. A systematic review of insomnia and complementary medicine. Sleep Med Rev 2011; 15:99.
- DK Cheuk et al. Acupuncture for insomnia. Cochrane Database Syst Rev 2012; 9:CD005472.

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