What medications can be prescribed (Rx) for short-term help with insomnia?

From the Guidelines

For short-term help with sleep, medications such as eszopiclone (1-3mg), zolpidem (5-10mg), and low-dose doxepin (3-6mg) can be prescribed, with the choice depending on individual factors like age, other medications, and specific sleep problems. When considering medication for short-term insomnia, it's essential to weigh the benefits against the potential risks and side effects.

• Benzodiazepines, such as temazepam and lorazepam, are effective but should be limited to 2-4 weeks due to dependence risk 1.
• Non-benzodiazepine "Z-drugs" like zolpidem and eszopiclone are also effective with potentially fewer side effects 1.
• Low-dose doxepin is an antidepressant commonly used off-label for sleep, with some evidence supporting its efficacy 1.
• Melatonin is milder but helpful for some, particularly with circadian rhythm issues, although evidence for its use in insomnia is limited 1. These medications should be taken 30-60 minutes before bedtime and used alongside good sleep hygiene practices. Short-term use is emphasized because these medications can lose effectiveness over time and may cause morning grogginess, confusion in older adults, or dependence with prolonged use. It's crucial to consider individual factors, such as age, other medications, and specific sleep problems, when selecting a medication for short-term insomnia 1.

From the FDA Drug Label

Zolpidem tartrate tablets are indicated for the short-term treatment of insomnia characterized by difficulties with sleep initiation. Zolpidem tartrate is used in adults for the short-term treatment of a sleep problem called insomnia (trouble falling asleep). The medication that can be prescribed for short-term help to sleep is Zolpidem.

• Key points:
  • It is used for the short-term treatment of insomnia.
  • It should be taken exactly as prescribed, on an empty stomach, and only when the patient can stay in bed for a full night (7 to 8 hours).
  • The patient should not take zolpidem with or after a meal, and should not drink alcohol before taking it. 2 2 2

From the Research

Medications for Short-Term Help with Sleep

The following medications can be prescribed for short-term help with sleep:

• Non-benzodiazepines, such as eszopiclone, zolpidem, and zaleplon, which have a lower risk of tolerance, dependence, abuse, and residual effects compared to benzodiazepines 3, 4
• Ramelteon, a melatonin receptor agonist, which is indicated for sleep-onset difficulties and is not scheduled 3, 5, 6
• Suvorexant, a dual orexin receptor antagonist, which can improve sleep maintenance insomnia 5, 6
• Low-dose doxepin, an H1 antagonist, which can improve sleep maintenance insomnia 5, 6
• Benzodiazepines, such as triazolam and temazepam, which can be used for short-term treatment of insomnia, but should be used with caution due to the risk of dependence and abuse 6

Considerations for Medication Use

When prescribing medications for short-term help with sleep, the following considerations should be taken into account:

• The risk of next-day residual effects, tolerance, dependence, and abuse 3, 4
• The potential for interactions with other medications 4
• The patient's medical history, including any history of substance abuse or psychiatric disorders 4
• The patient's age, with older adults being more susceptible to the side effects of hypnotics 6, 7

Off-Label Medications

Some medications are commonly used off-label for the treatment of insomnia, including:

• Trazodone, which can improve sleep quality and sleep continuity, but carries significant risks 5, 6
• Melatonin, which can slightly improve sleep onset and sleep duration, but product quality and efficacy may vary 6
• Valerian, which is relatively safe but has equivocal benefits on sleep quality 6