From the Guidelines
Non-benzodiazepine medication options for anxiety and sleep disorders include eszopiclone, zaleplon, and zolpidem, which are recommended for sleep onset and maintenance insomnia, as well as ramelteon and doxepin, which are suggested for sleep onset and 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.
Non-BZD Medications for Anxiety and Sleep Disorders
- Eszopiclone: suggested for sleep onset and maintenance insomnia, with recommended doses of 2 mg and 3 mg 1
- Zaleplon: suggested for sleep onset insomnia, with a recommended dose of 10 mg 1
- Zolpidem: suggested for sleep onset and maintenance insomnia, with a recommended dose of 10 mg 1
- Ramelteon: suggested for sleep onset insomnia, with a recommended dose of 8 mg 1
- Doxepin: suggested for sleep maintenance insomnia, with recommended doses of 3 mg and 6 mg 1
Important Considerations
- Non-benzodiazepine BZRAs, such as zolpidem, zaleplon, and eszopiclone, should be administered at the lowest effective dose and for the shortest possible duration to minimize adverse events 1
- The work group advised against the use of benzodiazepines or trazodone for the treatment of chronic insomnia disorder due to their adverse effect profiles and potential risks 1
- Regular follow-up is necessary to monitor the effectiveness of these medications and adjust treatment as needed 1
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
- The following non-benzodiazepine (non-BZD) medications are available for anxiety and sleep disorders:
- Selective serotonin reuptake inhibitors (SSRIs) such as sertraline, paroxetine, and fluoxetine 2
- Serotonin-potentiating non-SSRIs, such as venlafaxine, nefazodone, trazodone, and mirtazapine 2
- Anticonvulsants, such as pregabalin, carbamazepine, valproic acid, topiramate, and gabapentin 2, 3
- Atypical antipsychotics, such as quetiapine 2, 3
- Azapirones, such as buspirone 2, 4
- Melatonin receptor agonists, which have recently been approved for the treatment of insomnia 5
Efficacy and Acceptability of Non-BZD Medications
- Studies have shown that these non-BZD medications have varying degrees of efficacy and acceptability in the treatment of anxiety and sleep disorders:
- Pregabalin has been shown to rapidly reduce anxiety and has a safe side effect profile 3
- Quetiapine has been shown to have similar efficacy to SSRIs in low dosages, but with lower overall tolerability 3
- Azapirones, including buspirone, have been shown to be superior to placebo in treating generalized anxiety disorder (GAD) 4
- Duloxetine and escitalopram have been shown to have better efficacy, while vortioxetine has been shown to have better acceptability 6