From the Guidelines
I strongly advise against continuing the use of Doxylamine succinate 25mg for sleep, as it is not a recommended treatment for chronic insomnia in adults, according to the American Academy of Sleep Medicine clinical practice guideline 1. The patient's current use of Doxylamine succinate 25mg, an over-the-counter antihistamine, may provide short-term relief but is not ideal for regular use due to potential side effects such as daytime drowsiness, dry mouth, and cognitive impairment. Some key points to consider when evaluating alternative sleep medication options include:
- The American Academy of Sleep Medicine suggests using eszopiclone, zaleplon, or zolpidem as a treatment for sleep onset and sleep maintenance insomnia in adults 1.
- However, it is essential to note that these medications should be used with caution and under close supervision due to their potential for dependence and side effects.
- Cognitive behavioral therapy for insomnia (CBT-I) is a highly effective treatment option that can be used in conjunction with or instead of medication, and it has the added benefit of not carrying the same risks as pharmacological treatments. Before prescribing any new medication, it is crucial to assess the patient's sleep hygiene practices, screen for underlying conditions that may be contributing to their insomnia, and review their current medications to identify any potential interactions or side effects. By taking a comprehensive approach that addresses both the patient's immediate sleep needs and the underlying causes of their insomnia, we can develop an effective treatment plan that prioritizes their morbidity, mortality, and quality of life.
From the Research
Patient Request for Sleep Medication
- The patient is requesting sleep medication, having reported that melatonin is ineffective for them and that they are currently taking a Sleep Aid from Costco, which contains Doxylamine succinate 25mg.
- According to the study 2, Doxylamine succinate is an ethanolamine-based antihistamine used in the short-term management of insomnia due to its sedative effects.
Pharmacokinetics of Doxylamine Succinate
- The study 2 evaluated the pharmacokinetic dose proportionality between two strengths (12.5 mg and 25 mg) of doxylamine hydrogen succinate film-coated tablets in healthy volunteers, finding that exposure to doxylamine was proportional over the therapeutic dose range of 12.5-25 mg.
- Another study 3 found that food effects do not significantly impact the pharmacokinetics of doxylamine hydrogen succinate 25 mg film-coated tablets in healthy volunteers.
Alternative Treatment Options
- Cognitive Behavioral Therapy for Insomnia (CBT-I) is a recommended first-line treatment for chronic insomnia, as it produces sustained benefits without the risk of tolerance or adverse effects associated with pharmacologic approaches 4, 5.
- A study 6 explored ways to increase patient engagement with CBT-I, finding that patient education and provision of self-management CBT-I tools may be effective in motivating patients to try CBT-I.
Considerations for Patient Care
- When considering the patient's request for sleep medication, it may be helpful to discuss alternative treatment options, such as CBT-I, and provide education on the potential benefits and risks of each approach 4, 5, 6.
- The patient's current use of Doxylamine succinate 25mg should be taken into account when evaluating their treatment plan, considering the pharmacokinetics and potential interactions with other medications 2, 3.