Insomnia Pharmacotherapy (original) (raw)
Related papers
Journal of central nervous system disease, 2018
Insomnia remains a common clinical concern that is associated with negative daytime consequences for patients and represents a significant public health problem for our society. Although a variety of therapies may be employed to treat insomnia, the use of medications has been a dominant approach. Regulatory agencies have now classified insomnia medications into 4 distinct pharmacodynamics classes. Medications with indications approved for insomnia treatment include benzodiazepine receptor agonists, a melatonin receptor agonist, a selective histamine receptor antagonist, and a dual orexin/hypocretin receptor antagonist. Both pharmacodynamic and pharmacokinetic advances with hypnotic medications in recent years have expanded the pharmacopoeia to allow personalized treatment approaches for different patient populations and individual sleep disturbance patterns.
Comparative Tolerability of Newer Agents for Insomnia
Drug Safety, 2009
Newer treatment options for insomnia include the non-benzodiazepine hypnotics zolpidem, zolpidem-controlled release, zaleplon, zopiclone, eszopiclone and the melatonin receptor agonist, ramelteon. These compounds are generally well tolerated and present favourable safety profiles in comparison with the older benzodiazepines and barbiturates. Commonly cited impairments of memory formation and decrements in psychomotor performance are related to the mechanism of action of hypnotics, and are both dose-and time-dependent. These effects typically are minimal on the morning following night-time administration. The non-benzodiazepines are associated with some risk for dependence and abuse. However, concerns regarding such risks appear to be greater than warranted by empirical evidence. The appropriate therapeutic use of hypnotics is generally not associated with physiological responses that are commonly thought to lead to dependence, such as tolerance or discontinuation effects. Former substance abusers and psychiatric patients appear to be at greatest risk. The labelling of hypnotics was recently updated to incorporate warnings about very rare, but serious adverse events that have been identified in postmarketing surveillance. These events include anaphylaxis (severe allergic reaction); angio-oedema (severe facial swelling); and complex sleep-related behaviours, which may include sleep-driving, making phone calls and preparing and eating food. This article will review the adverse event profiles of these newer sedative hypnotics, their effects on memory and psychomotor performance, abuse liability concerns and the most recent information about the rare adverse effects that prompted the recent revision to the labelling of drugs in the hypnotic class.
Pharmacotherapeutic options for treatment of insomnia
International Journal of Basic & Clinical Pharmacology, 2014
REM) stage of sleep with decreased overall sleep quality and sleep efficiency (total sleep time [TST]/total bedtime). TST changes with age, i.e., sleep time requirement is over 18 hrs for neonates, 11 hrs for young children, 9 hrs for adolescents, and about 7.5 hrs for adults. 4
Non-benzodiazepines for the treatment of insomnia
Sleep Medicine Reviews, 2000
Benzodiazepine hypnotics, the mainstay of pharmacological treatment for insomnia, have been associated with altered sleep architecture, psychomotor and memory impairment, rebound insomnia, withdrawal effects, tolerance, dependence, abuse potential and respiratory depression. Non-benzodiazepines, such as zolpidem, zopiclone and zaleplon, demonstrate hypnotic efficacy similar to that of benzodiazepines along with excellent safety profiles. Non-benzodiazepines generally cause less disruption of normal sleep architecture than benzodiazepines. Psychomotor and memory impairment may be less problematic with non-benzodiazepines, especially when compared to longer-acting benzodiazepines. Rebound insomnia and withdrawal symptoms occur infrequently upon discontinuation of non-benzodiazepines and may be less common and milder than those seen upon discontinuation of some benzodiazepines. For the long-term treatment of insomnia, which is generally not recommended, zolpidem and zopiclone are particularly good options because they do not develop tolerance rapidly and have a low abuse potential. Limited data indicate that zaleplon has low tolerance and abuse potential, although further experience is needed to determine its long-term efficacy and safety profile. Since non-benzodiazepines produce minimal respiratory depression, they may be safer than benzodiazepines in patients with respiratory disorders. The choice of which hypnotic to use should be based on the patient's primary sleep complaint, health history, adverse effects and cost.
Current Patterns and Future Directions in the Treatment of Insomnia
Annals of Clinical Psychiatry, 2005
Background. Despite the high prevalence and the high burden associated with chronic insomnia, it remains largely unrecognized and often inadequately treated by physicians. Methods. A review was undertaken of the literature on barriers to both acute and chronic treatment of insomnia, as well as recent trials of pharmacologic and nonpharmacologic agents for insomnia. Results. Obstacles to appropriate treatment of the condition include outdated insomnia management guidelines, which have contributed to US Food and Drug Administration restrictions on longer-term prescription of hypnotic agents; lack of research demonstrating the benefit of treating insomnia; and fears of tolerance and withdrawal effects of long-term use of hypnotic agents, as well as an absence of longer-term, randomized, controlled, double-blind trials of existing agents used to treat insomnia. Conclusions. There is evidence that improved sleep may improve outcome in some medical and psychiatric illnesses. Both behavioral and pharmacologic therapies have shown efficacy in chronic insomnia. In addition, a recent 6-month, randomized, controlled study has demonstrated that at least one agent may be safe and effective in longer-term use.
Modern standards for pharmacological treatment of insomnia
Pediatria i Medycyna Rodzinna, 2019
In clinical practice, insomnia can be classified as temporary and chronic. They differ in duration. Chronic insomnia lasts over 3 months, with symptoms occurring at least 3 times a week. Insomnia treatment standards were defined e.g. by the American Academy of Sleep Medicine in 2017. There are two treatment approaches. First, non-pharmacological methods should be applied, which are the basis of treatment and guarantee its sustained effect. These methods include abiding hygiene of sleep rules, sleep period limits, stimuli control and cognitive therapy. The second form of treatment is pharmacotherapy. It is based on benzodiazepine receptor agonists, which have replaced previous benzodiazepines. They have less side effects and lower addictive potential. This group includes zolpidem, zaleplon and zopiclone. Dosing regimen mainly depends on the form of insomnia being treated: temporary or chronic. Accidental and temporary insomnia should be treated with hypnotics without delay. It is advised to have a pill near one's bed and take it only when the patient waits too long to fall asleep after laying down or after an arousal. Such dosing scheme significantly reduces the risk of addiction and lowers the risk of transformation of insomnia into the chronic form. In chronic insomnia, when benzodiazepines are taken daily, 2 week period cannot be exceeded. Prolonged time is only allowed when using the drugs 2-3 times a week (or up to 10 times a month). Such pharmacotherapy guidelines are easier to tolerate, when the patient simultaneously complies with behavioural therapy. Besides that, a tricyclic antidepressant drug can also be used-doxepin. The list of inadvisable medications for the treatment of insomnia is composed of: trazodone, tiagabine, diphenhydramine, melatonin, tryptophan, valerian.