From the Guidelines
Non-benzodiazepine medication options for anxiety and sleep disorders include eszopiclone, zaleplon, and zolpidem, which are suggested for use as a treatment for sleep onset and sleep maintenance insomnia in adults, as well as ramelteon and doxepin, which are recommended for sleep onset and sleep maintenance insomnia, respectively. These medications have been shown to improve sleep efficiency, sleep onset latency, sleep quality, total sleep time, and wake after sleep onset compared to placebo 1. The use of non-benzodiazepine BZRAs, such as zolpidem, zaleplon, and eszopiclone, is recommended for the treatment of chronic insomnia disorder, as they have been found to improve sleep outcomes with a relatively low risk of adverse events 1. Some key points to consider when prescribing these medications include:
- Using the lowest effective dose and shortest possible duration to minimize adverse events
- Counseling patients on the potential risks, including serious injuries caused by sleep behaviors
- Avoiding the use of benzodiazepines and trazodone due to their adverse effect profiles and limited efficacy
- Considering alternative options, such as melatonin and magnesium, for patients who may not be suitable for non-benzodiazepine BZRAs. It is essential to weigh the benefits and potential harms of these medications and to individualize treatment based on patient-specific factors, such as medical history, age, and comorbidities.
From the FDA Drug Label
PROZAC 20MG Package Label The FDA drug label does not answer the question.
From the Research
Non-BZD Medications for Anxiety and Sleep Disorders
- Non-benzodiazepine benzodiazepine receptor agonists are currently first-line medication treatment for insomnia 2
- Selective melatonin receptor agonists have been approved for the treatment of insomnia 2
- Pregabalin, an anticonvulsant, has a robust level of evidence in the treatment of generalized anxiety disorder (GAD) and rapidly reduces anxiety with a safe side effect profile 3
- Quetiapine, an antipsychotic, is also a promising non-antidepressant treatment for GAD, with similar efficacy to SSRIs in low dosages 3
- Buspirone and hydroxyzine are FDA-approved for GAD and have relatively good evidence of efficacy 3
- Other non-BZD medications that may be used for anxiety and sleep disorders include:
- Antidepressants such as selective serotonin reuptake inhibitors (SSRIs) and selective serotonin and noradrenalin reuptake inhibitors (SNRIs) 4, 5
- Azapirones, which have been used effectively for generalized anxiety disorder 5
- Anticonvulsants, which may have an adjunctive role to antidepressants in cases of treatment resistance 5
- Atypical antipsychotics, which may have an adjunctive role to antidepressants in cases of treatment resistance 5