![]() ![]() However, Belsomra has shown effectiveness compared with placebo, as patients fell asleep 10 minutes faster and slept for 23 minutes longer. ![]() Unfortunately, there haven’t been any updated treatment guidelines for sleep disorders since Belsomra was made available, and there also haven’t been head-to-head studies with established therapies, so it is hard to tell its place in therapy. Suvorexant (Belsomra), the newest drug to enter the dual orexin receptor antagonists party, was introduced to the market in the summer of 2014.īelsomra works to inhibit/antagonize the orexin receptor, which normally promotes wakefulness. However, the abuse potential of benzodiazepines is stronger because they have less-selective binding to the GABA A receptors. Of note, however, oxazepam is not approved for sleep disorders, but the others are.īecause benzodiazepines have shorter durations of action, the next-day hangover effect is not as prominent for benzodiazepines as it is for the “Z” sedative-hypnotics. The acronym LOT (lorazepam, oxazepam, temazepam) will be help you remember the less harmful benzodiazepines. 2 The longer-acting benzodiazepines are more strongly associated with increases in falls and included in the American Geriatrics Society’s Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. There a lot of benzodiazepines on the market for various mental health conditions, but for insomnia, a shorter-acting agent in this class is generally better tolerated. 3 The FDA has also warned that eszopiclone and zolpidem can impair next-day operation of machinery and driving. In 2013, the recommended dosing for zolpidem in women was lowered to 5 mg for the immediate-release version and 6.25 mg for extended-release products. In addition, the FDA has issued some safety alerts concerning the use of zolpidem and eszopiclone. Zolpidem, zaleplon, and eszopiclone also have some weird side effects like parasomnias and vivid dreams. The most common side effects involve the next-day hangover effect of residual somnolence/drowsiness, dizziness, and ataxia. For instance, there is related risk for abuse and dependence, so the drugs are listed as controlled substances. These drugs do have their issues, though. Eszopiclone has a longer half-life than the other “Z” sedative-hypnotics, so it should be used in patients who plan on sleeping for at least 7 hours. Zaleplon has a quick onset and shorter duration of action, which makes it useful in midnight awakening. Zolpidem comes in a variety of formulations that are useful in many types of insomnia. They are widely considered as part of first-line drug therapy for insomnia. ![]() In clinical studies, these drugs have been shown to improve onset and duration of sleep. Zolpidem (Ambien, Intermezzo), zaleplon (Sonata), and eszopiclone (Lunesta) work as facilitators/agonists of GABA A receptors in the body’s central nervous system to inhibit brain activity. Upon follow up, I plan to provide her with the following types of medications that can be used for sleep disorders: I could have listed 10 different drugs to try, but instead I told her to attempt the cognitive behavioral therapies and follow up in a week if they don’t work. My head started racing with all the different treatment options that could help this woman.Īt first, I recommended some cognitive behavioral therapies, including removal of electronics from her room, avoidance of certain foods and drinks close to bedtime, and reduction of other stimuli. Her doctor made a few recommendations for prescription drug therapies, but she couldn’t remember the names. I recently consulted with a patient who approached the pharmacy counter to ask for something that could help her sleep. ![]()
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