Table 2. Recommendations on switching hypnotic medication.
| Original drug class/group | Recommendations on switching to another drug class | Level of evidence*1 | Effect size*2 [95% CI] | Recommendations on switching within one drug class | Level of evidence*1 | Effect size*2 [95% CI] |
|---|---|---|---|---|---|---|
| Benzodiazepines | Slowly gradually/ overlapping (e18, e20–e22, e25, e35) | 1b | 0.32 [0.15; 0.49] | Direct switch (e23, e24) | 1a | 0.41 [0.31; 0.83] |
| Z-drugs | Slowly gradually and then wait for 1–2 days/ overlapping (14, e21) | 1a | 0.34 [0.18; 0.65] | Slowly gradually and then wait for 1–2 days/ overlapping (14, e21, e26) | 1a | 0.38 [0.27; 0.71] |
| Daridorexant | Direct switch (11–13) | 1b | 0.24 [0.11; 0.43] | Direct switch (11, e27) | 1b | 0.27 [0.14; 0.41] |
| Mirtazapine | Slowly gradually/ overlapping | 5 | Not applicable | Not recommended | 5 | Not applicable |
| Trazodone | Slowly gradually/ overlapping | 4 | Not applicable | Not recommended | 5 | Not applicable |
| Doxepin | Direct switch (e28, e29) | 1b | 0.35 [0.20; 0.69] | Not stated | 5 | Not applicable |
| Agomelatine | Direct switch | 4 | Not stated | 5 | Not applicable | |
| Other and higher dosed tricyclic antidepressants | Slowly gradually/ overlapping | 4 | Not applicable | Not recommended | 5 | Not applicable |
| Quetiapine and other antipsychotics | Slowly gradually/ overlapping | 4 | Not applicable | Direct switch, e.g., quetiapine immediate release to prolonged release | 5 | Not applicable |
| Pregabalin, gabapentin | Slowly gradually / overlapping | 5 | Not applicable | Direct switch | 5 | Not applicable |
| Melatonin | Direct switch (e30–e33) | 2b | 0.21 [0.12; 0.54] | Direct switch, e.g., immediate release to prolonged release | 4 | Not applicable |
| Antihistamines | Direct switch | 5 | Not applicable | Not recommended | 5 | Not applicable |
| Valerian phytotherapeutics | Slowly gradually/ overlapping | 5 | Not applicable | Direct switch, possibly from ethanol-extracted to methanol-extracted substance | 5 | Not applicable |
| Other herbal medicines | Direct switch | 5 | Not applicable | Direct switch | 5 | Not applicable |
*1
Levels of evidence were defined according to the 2009 Oxford ranking system t (e34).
*2
Relative risk of renewed use of the discontinued medication after completion of the switch [95% CI], 95% confidence interval