From the Guidelines
The most effective medications for treating insomnia include eszopiclone, zolpidem, and suvorexant, which have been shown to improve sleep outcomes and global outcomes in adults with chronic insomnia disorder. These medications, including benzodiazepine receptor agonists like eszopiclone and zolpidem, and orexin receptor antagonists like suvorexant, are recommended for short-term use due to their potential for dependence and side effects 1.
Some key points to consider when prescribing these medications include:
- Eszopiclone is recommended for sleep onset and sleep maintenance insomnia, with a dosage of 2-3 mg per night 1.
- Zolpidem is recommended for sleep onset insomnia, with a dosage of 10 mg per night 1.
- Suvorexant is recommended for sleep maintenance insomnia, with a dosage of 10-20 mg per night 1.
- These medications should be used at the lowest effective dose for the shortest duration possible to minimize side effects and dependence 1.
It's also important to note that cognitive behavioral therapy for insomnia (CBT-I) is a recommended first-line treatment for chronic insomnia disorder, and can be used in conjunction with pharmacologic therapy 1. Additionally, sedating antidepressants like trazodone, mirtazapine, and doxepin may be used for longer-term management of insomnia, although their efficacy for this indication is not well established 1.
Overall, the choice of medication for insomnia should be based on the individual patient's needs and medical history, and should be used in conjunction with good sleep hygiene practices for best results.
From the FDA Drug Label
Eszopiclone tablets are indicated for the treatment of insomnia. Zolpidem was evaluated in two controlled studies for the treatment of patients with chronic insomnia Ramelteon tablets are indicated for the treatment of insomnia characterized by difficulty with sleep onset.
Medications used to treat insomnia include:
From the Research
Medications for Insomnia
Medications used to treat insomnia include:
- Nonbenzodiazepine hypnotic medications, such as zolpidem, zaleplon, and eszopiclone 5
- Melatonin agonists, such as ramelteon 5
- Tri-cyclic antidepressants, such as low-dose doxepin 5, 6, 7
- Hypocretin/orexin antagonists, such as suvorexant 6, 7
- Benzodiazepines, although their use is not recommended due to high abuse potential 6
Specific Medications for Different Types of Insomnia
- For sleep-onset insomnia: ramelteon, short-acting Z-drugs 7
- For sleep maintenance insomnia: suvorexant, low-dose doxepin 7
- For both sleep onset and sleep maintenance: eszopiclone, zolpidem extended release 7
- For middle-of-the-night awakenings: low-dose zolpidem sublingual tablets, zaleplon 7
Comparison of Medications
- Eszopiclone and lemborexant have a favorable profile, but eszopiclone may cause substantial adverse events 8
- Doxepin, seltorexant, and zaleplon are well tolerated, but data on efficacy and other important outcomes are scarce 8
- Benzodiazepines can be effective in the acute treatment of insomnia, but are associated with poor tolerability 8
- Melatonin, ramelteon, and non-licensed drugs did not show overall material benefits 8