Table 1.
Drugs used for the treatment of chronic insomniaa.
| Dosage | ||||
|---|---|---|---|---|
| Drug name | SOI | SMI | (mg) | Adverse events |
| Z-drugs | ||||
| Eszopicloneb | • | • | 1–3 | Metallic taste, dry mouth, nocturnal complex behaviors |
| Zaleplonb | • | 5 to 10 | Headache, fatigue, somnolence, asthenia | |
| Zolpidemb | • | 5 to 10 | Drowsiness, excessive sleepiness, hallucinations, depression, nocturnal complex behaviors | |
| Zolpidem, CRb | • | • | 6.25 to 12.5 | Drowsiness, headache, next-day somnolence, dizziness |
| Zolpidem, SLb | •c | 1.75 or 3.5 | Drowsiness, excessive sleepiness, hallucinations, depression, nocturnal complex behaviors | |
| Zolpidem, oral sprayb | • | 5–10 | Drowsiness, dizziness, diarrhea, drugged feeling | |
| Melatonin agonists | ||||
| Melatonin | 1 | Headache, somnolence | ||
| Ramelteonb | • | 8 | paradoxical worsening of insomnia; avoid combination with cytochrome inhibitors especially fluvoxamine; contraindicated in those with severe hepatic impairment | |
| Antidepressants | ||||
| Amitriptyline | 25 to 150 | Orthostatic hypotension, cardiac arrhythmias, | ||
| Doxepinb | 3 to 6 | dizziness, dry mouth, blurred vision, constipation, and urinary retention. It should not be co-administered with MAOI and Tolazamide. | ||
| Mirtazapine | 7.5 to 15 | Dry mouth, drowsiness, sedation, weight gain | ||
| Nortriptyline | 25 to 150 | Fatigue, lethargy, constipation, orthostatic hypotension, suicidal ideations | ||
| Trazodone | 50 to 100 | Residual daytime sedation, orthostatic hypotension, headache, nausea, vomiting, xerostomia, priapism | ||
| Orexin receptor antagonist | ||||
| Suvorexantb | • | • | 5–20 | Somnolence, narcolepsy, headache, dry mouth |
| Antihistamines | ||||
| Diphenhydramine | 25 to 50 | Somnolence, dry mouth, dizziness, dyskinesia | ||
| Doxylamine | 25 to 50 | Blurred vision, constipation, dizziness, paresthesia, nightmares | ||
| Hydroxyzine | 50–100 | Drowsiness, dry mouth, hallucination | ||
| Antipsychotics | ||||
| Olanzapine | 2.5 to 20 | Orthostatic hypotension, dyslipidemia, Type 2 diabetes, weight gain, extrapyramidal symptoms. Gynecomastia, neuroleptic malignant syndrome | ||
| Quetiapine | 50 to 400 | Orthostatic hypotension, dyslipidemia, weight gain, neuroleptic malignant syndrome, tardive dyskinesia | ||
| Risperidone | 0.25 to 6 | Orthostatic hypotension, ketoacidosis, hyperglycemia, tardive dyskinesia, hyperprolactinemia | ||
| Anticonvulsants | ||||
| Gabapentin | 300 to 600 | Drowsiness, somnolence, beneficial inpatients with restless leg syndrome | ||
| Pregabalin | 50 to 300 | Peripheral edema, dizziness, weight gain, blurred vision, seizures, suicidal ideations, |
SOI = Sleep-onset insomnia; SMI-Sleep maintenance insomnia; CR = continuous release; SL = sublingual
*a
The list excludes benzodiazepines
b
FDA approved drugs
c
provided four additional hours of sleep/time in bed before planned awakening.