From the Guidelines
Medications such as eszopiclone, zolpidem, and suvorexant may be considered for insomnia treatment with minimal risk of weight gain, as they have shown improvement in short-term global and sleep outcomes for adults with insomnia disorder 1. When considering medications for insomnia that do not cause weight gain, it's essential to evaluate the potential benefits and harms of each option.
- Eszopiclone, zolpidem, and suvorexant have been found to improve short-term sleep outcomes, but their long-term efficacy and comparative effectiveness are not well established 1.
- These medications may cause cognitive and behavioral changes, and may be associated with infrequent but serious harms, such as increased risk for dementia, fractures, and major injury 1.
- It's crucial to use these medications at the lowest effective dose and for the shortest duration possible, typically not exceeding 2-4 weeks of continuous use.
- Non-medication approaches like cognitive behavioral therapy for insomnia (CBT-I), sleep hygiene improvements, and addressing underlying conditions should be considered first or alongside medication for optimal results.
- Ramelteon, a melatonin receptor agonist, is another option that is generally weight-neutral at the typical dose of 8mg taken 30 minutes before bedtime.
- Low-dose doxepin (3-6mg) is another option with minimal weight effects, but its use should be carefully considered due to potential cognitive and behavioral changes.
- Ultimately, the choice of medication should be individualized, taking into account the patient's specific needs, medical history, and potential risks and benefits 1.
From the Research
Medications for Insomnia
Medications for insomnia can have various side effects, including weight gain. However, some medications may be less likely to cause weight gain than others.
- Controlled-release melatonin and doxepin are recommended as first-line agents in older adults, and may be considered for the general population with difficulty falling asleep or staying asleep 2.
- The z-drugs (zolpidem, eszopiclone, and zaleplon) can be considered for those who have difficulty falling asleep or staying asleep, but may have a higher risk of adverse effects such as falls and hip fractures 2, 3.
- Ramelteon, a selective melatonin receptor agonist, has been shown to improve sleep quality and reduce sleep latency, with a low risk of adverse effects 4.
- Non-benzodiazepine hypnotics, such as zolpidem and eszopiclone, have been shown to have a better safety profile and longer-term efficacy compared to older medications, but may still have risks such as dependence and abuse 5, 6.
Weight Gain Risk
There is limited information available on the specific risk of weight gain associated with these medications. However, it is generally recommended to monitor patients for changes in weight and adjust treatment as needed.
- A study on zolpidem found that it was not associated with significant changes in body weight 3.
- A study on ramelteon found that it was not associated with significant changes in body weight or body mass index 4.
- A review of non-benzodiazepine hypnotics found that they were generally well-tolerated and had a low risk of adverse effects, including weight gain 6.