Sleep Medications

• Insomnia
  • Inpatient
    • 1) Ramelteon (Rozerem)
      • 8mg, Melatonin Agonist, Sleep onset, rapid, short duration
    • 2) Trazodone (Desyrel)
    • 3) Zyprexa/Diphenhydramine
  • Outpatient
    • 1) Melatonin
    • 2) Zolpidem (Ambien), Zaleplon, Eszopiclone
      • Non-Benzo GABA receptor agonists
      • Best used less than 2 weeks
    • 3) Doxepin (Silenor)
    • 4) Trazodone
• Sedating
  • Amitriptyline (Elavil)
  • Doxepin (Silenor)
    • 3-6mg, TCA, H1 antagonist for sleep maintenance, H1/H2 for urticaria
    • Best choice for chronic therapy, rapid onset, intermediate duration
  • Mirtazapine (Remeron)
• Eszopiclone (Lunesta)
  • 1≥3mg, Sleep maintenance, rapid, intermediate duration
    • Increases total sleep time via increases in stage 2 NREM sleep
  • SE: impaired driving, memory, coordination
• Hydroxyzine (Vistaril)
• Zaleplon
  • 5≥20mg, Sleep onset, rapid, short duration
  • Little effect on total sleep time
• Zolpidem (Ambien)
  • Sleep onset and/or Maintenance
  • 5-10mg rapid onset, short duration
  • ER: 6.25-12.5mg rapid, intermediate duration
  • Sublingual:
    • Intermezzo: 1.75-3.5mg, rapid, ultra-short duration
    • Edluar: 5-10mg rapid, short duration
    • Oral spray: 5-10mg rapid, short duration
• Suvorexant (Belsomra)
  • Orexin receptor antagonist
  • Sleep onset and/or Maintenance
  • 10-20mg slow, long duration
  • SE: Narcolepsy/Cataplexy
• Lemborexant (Dayvigo)
  • Orexin receptor antagonist
  • Sleep onset and/or Maintenance
  • 5-10mg rapid, intermediate duration