Table 2. FDA-Approved Hypnotics for Insomnia1.
| Generic Name | Trade Name | Indication | Geriatric Dose | Half life in older persons (hours) | Comments |
|---|---|---|---|---|---|
| Benzodiazepines2 | |||||
| flurazepam | Dalmane® | Short term treatment of insomnia | 15 mg | 126-158 | Should not be used in older adults because of very long half-life |
| quazepam | Doral® | 7.5 mg | 78 | Should not be used in older adults because of very long half-life | |
| estazolam | ProSom™ | 0.5-1 mg | 10-24 | Due to long half-life, residual CNS effects are likely. | |
| temazepam | Restoril® | 7.5-15 mg | 3.5-18.4 | ||
| triazolam | Halcion® | 0.0625-0.25 mg | 1.7-5 | Poor choice due to very short half life and high incidence of CNS adverse reactions | |
| Nonbenzodiazepines3 | |||||
| eszopiclone | Lunesta® | No short-term limitation for use; sleep onset and sleep maintenance insomnia | 1-2 mg | 9 | AEs>10%: headache, unpleasant taste |
| zolpidem ER | Ambien CR® | 6.25 mg | 1.9-7.3 | AEs>10%: dizziness, headache, somnolence | |
| zolpidem | Ambien® | 5 mg | 2.9-3.7 | AEs>10%: dizziness, headache, somnolence | |
| zaleplon | Sonata® | 5 mg | 1 | AEs: nausea (7%), myalgias (7%) | |
| Melatonin receptor agonist | |||||
| ramelteon | Rozerem™ | No short-term limitation for use; sleep onset insomnia | 8 mg | 1-2.6 | AEs: Headache (7%) Somnolence (5%) Dizziness (5%) Not a Class C-IV scheduled drug |
1
New interpretive guidelines (F329) from CMS also mandate quarterly review of sedative-hypnotic compounds for residents of long-term care facilities to assess continued need, dose and possible side-effects including possible decline in functional status or increased incidence of falls.
2
All are Class C-IV scheduled drugs, and may also be associated with amnesia and complex sleep-related behaviors such as sleepwalking or sleep-eating.
3
The nonbenzodiazepines have a fast onset of action (30-45 minutes).