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Sleep Medication Guide - The Carlat Guide to Medications Used for Insomnia


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From The Carlat Report Psychiatry, November 2011

(Obviously Ignore the Benzos and Z drugs)

This lists OTC and prescribed meds for insomnia with dosages and side effects - YOUR MILEAGE MAY VARY.  THIS IS NOT A RECOMMENDATION TO USE OR NOT TO USE ANY ADJUNCT MEDS FOR BENZODIAZEPINE WITHDRAWAL.

 

The Carlat Guide to Medications Commonly Used for Insomnia

Medications Usual Dose Range (mg) Half-Life (in hours) Side Effects

Benzodiazepines

Alprazolam (Xanax) 0.5 mg–1 mg 11–16

Side effects vary, but the most common

among the benzodiazepines are

lightheadedness, cognitive impairment,

tolerance, dependence, and withdrawal upon

discontinuation

Clonazepam (Klonopin) 0.5 mg–1 mg 20–80 More likely to cause next day sedation

Lorazepam (Ativan) 0.5 mg–1 mg 10–20

Temazepam (Restoril)* 15 mg–30 mg 8–20

Non-benzodiazepines

Eszopiclone (Lunesta)1* 1 mg–3 mg 5–7 Dry mouth, unpleasant taste

Zaleplon (Sonata)* 5 mg–20 mg 1 Least likely to cause next day sedation

Zolpidem (Ambien)* 5 mg–10 mg 1.5–2.4

Most frequently reported for all in this class

are headache, next day sedation, dizziness,

and nausea; zolpidem can cause sleep-related

“complex behaviors” (eg, preparing and eating

food, making phone calls, or having sex) all of

which have been reported in patients who are

not fully awake after taking a hypnotic

Zolpidem extended release (Ambien CR)* 6.25 mg–12.5 mg 1.5–2.4 See zolpidem

Antidepressants

Amitriptyline (Elavil) 10 mg–25 mg 10–26 Weight gain, next day sedation, constipation,

cognitive impairment

Doxepin (Silenor)1* 3 mg–6 mg 15.3 (terminal)2 Next day sedation, nausea

Mirtazepine (Remeron) 15 mg–30 mg 20–40 Next day sedation, weight gain

Trazodone (Desyrel) 25 mg–100 mg 3–6 (first phase), 5–9

(second phase)

Next day sedation, orthostatic hypotension,

priapism

Other Medications

Diphenhydramine (Benadryl) 25 mg–50 mg 3.4–9.2 Dry mouth, next day sedation, memory

impairment

Melatonin 0.3–5 mg 30 minutes to 2 hours Headache

Quetiapine (Seroqeul) 25 mg–50 mg 6

Weight gain, next day sedation, elevated

cholesterol/triglycerides; risk of TD/EPS; use

as hypnotic controversial due to expense and

side effects

Ramelteon (Rozerem)1* 8 mg 1.5–5 Headache, next day sedation, dizziness

Many other medications are sometimes used to treat insomnia. We have only listed those most commonly used here.

*FDA-approved for insomnia.

1No long-term use limitation. All other medications in the table are DEA Class C-IV. (These drugs are considered highly abusable.) 2Half-life of doxepin

does not correspond to length of sedation.

up out of bed to engage in complex sleep

behavior—such patients may need to be

switched to another medication.

Melatonin agonist. The only drug in

this class so far is ramelteon (Rozerem).

Since it doesn’t bind to GABA, it doesn’t

have the troublesome GABA-agonist

side effects, and may be a good choice

 

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