Medications & Rx for Sleep Problems
Medications with Regulatory Approval for Insomnia
- Benzodiazepine receptor agonists
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Benzodiazepine hypnotics
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Nonbenzodiazepine BZRAs
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- The newer dual-orexin-receptor antagonists
- Histamine receptor antagonist (low-dose Hydroxyzine, or Doxepin)
- Melatonin receptor agonists (Ramelteon)
Medications Prescribed Off-Label for Insomnia
Antidepressants
- Trazodone
- Mirtazapine
- Amitriptyline
|
Nonbenzodiazepine |
Clinical use* |
Preparations (brand name) |
|
Eszopiclone |
Sleep onset or sleep maintenance insomnia |
Tablet (Lunesta) |
|
Zaleplon |
Sleep onset insomnia |
Capsule (Sonata) |
|
Zolpidem |
Sleep onset or sleep maintenance insomnia |
Tablet (Ambien), sublingual tablet (Edluar), oral liquid (Zolpimist; 5 mg per spray) |
|
Zolpidem extended release |
Sleep onset or sleep maintenance insomnia |
Coated tablet (Ambien CR) |
|
Zolpidem middle of the night |
Sleep maintenance insomnia (middle of the night) |
Sublingual tablet (Intermezzo; 1.75 mg, 3.5 mg) |
|
Zopiclone (not available in the United States) |
Sleep onset or sleep maintenance insomnia |
Tablet |
New – FDA Approves Daridorexant for Treatment of Insomnia
The FDA RECENTLY approved daridorexant (Quviviq, Idorsia Pharmaceuticals) for the treatment of individuals with insomnia, characterized by difficulties with sleep onset and/or sleep maintenance. The properties of Daridorexant include a potent inhibition of both orexin receptors, a rapid absorption for sleep onset, and a pharmacokinetic profile such that around 80% of daridorexant has been eliminated after a night of sleep to help minimize residual effects,
The journal Lancet reported data on Daridorexant in two multicentre, randomised, double-blind, placebo-controlled, trials at 156 sites in 18 countries. Daridorexant reduced the wake time after sleep onset (the length of time when a person awakens after falling asleep) as compared to placebo, and that the 50 mg dose was more effective than the 25mg dose. Nasopharyngitis and headache were the most common adverse events in all groups.
