Table 5.
Pharmacologic Treatment of Insomnia in Kidney Failure
| Class | Drug | Adverse Effects | Kidney Failurea |
|---|---|---|---|
| Benzodiazepine-receptor agonists | Temezapam (Restoril), lorazepam (Ativan), triazolam (Halcion) | Sedation, ataxia, hypotension, dizziness, daytime impairment | No dose adjustment, no studies |
| Nonbenzodiazepine- benzodiazepine receptor agonists | Eszopiclone (Lunesta), zolpidem (Ambien), zaleplon (Sonata), zopicloneb | Sedation, ataxia, hypotension, unpleasant taste of eszopiclone | No dose adjustment; zaleplon and zolpidem have each been studied in small singular studies in hemodialysis patients |
| Antidepressants | Trazodone (Desyrel), mirtazapine (Remeron), doxepin (Sinequan, Silenor) | Sedation, anticholinergic effects, weight gain (mirtazapine) | No dose adjustment, no studies |
| Orexin antagonist | Suvorexant (Belsomra) | Drowsiness, headaches, dizziness | No dose adjustment, no studies |
| Melatonin agonist | Ramelteon (Rozerem) | Sedation | No dose adjustment, no studies |
| Melatonin | Melatonin | Drowsiness | No dose adjustments; improvement of sleep quality at 6–12 wk, lost by 12 mo |
a
Although no dose adjustments are needed, these drugs should be used with caution in hemodialysis patients given the serious adverse effects. Generally recommended use is for a short time, starting low and titrating slowly, and monitoring closely for adverse events and polypharmacy.
b
Not currently available in United States.