Controlled Substance Status of Zaleplon and Suvorexant
Yes, both zaleplon and suvorexant are Schedule IV controlled substances under the Controlled Substances Act due to their potential for abuse or dependency. 1, 2, 3
Zaleplon (Schedule IV)
Zaleplon is classified as a Schedule IV federally controlled substance because it is a benzodiazepine receptor agonist (BzRA) with demonstrated abuse potential, though this potential is lower than traditional benzodiazepines. 1, 4
Despite its controlled status, zaleplon 10 mg is recommended by the American Academy of Sleep Medicine as a first-line pharmacotherapy option for sleep-onset insomnia in adults with mild insomnia who have no contraindications. 1
Zaleplon has a very short half-life (approximately 1 hour) with minimal residual sedation, making it particularly suitable for patients who need help with sleep initiation but want to avoid next-day impairment. 1, 5, 6
The abuse potential of zaleplon exists but is generally lower than traditional benzodiazepines, with no evidence of tolerance development during recommended treatment periods (2–4 weeks) and minimal withdrawal effects upon discontinuation. 5, 6
Suvorexant (Schedule IV)
Suvorexant is also a Schedule IV controlled substance because it demonstrated abuse potential in controlled studies, though the overall abuse liability may be lower than zolpidem based on certain measures. 2, 3
The American Academy of Sleep Medicine suggests suvorexant for sleep-maintenance insomnia, with moderate-quality evidence showing it reduces wake after sleep onset by 16–28 minutes. 1, 7
Suvorexant works through a completely different mechanism (orexin receptor antagonism) compared to benzodiazepine-type agents, which may offer advantages for patients with substance use concerns, though it remains a controlled substance. 1, 7
In abuse-potential studies, suvorexant had significantly fewer effects than zolpidem 30 mg on secondary measures such as "high" visual analog scale scores and euphoric mood, with a numerically lower incidence of abuse-related adverse events like hallucinations. 2
Clinical Implications for Prescribing
Both medications require DEA registration and prescription monitoring in accordance with Schedule IV regulations, including limits on refills and documentation requirements. 4, 3
For patients with a history of substance abuse, ramelteon 8 mg is the preferred alternative because it is a melatonin receptor agonist with zero abuse potential and is not a DEA-scheduled medication. 1
Cognitive Behavioral Therapy for Insomnia (CBT-I) should be initiated before or alongside any pharmacotherapy, as it provides superior long-term outcomes without the regulatory and abuse concerns associated with controlled substances. 1, 7
When prescribing either zaleplon or suvorexant, use the lowest effective dose for the shortest duration possible (typically ≤4 weeks), with regular reassessment after 1–2 weeks to evaluate continued need and monitor for signs of misuse or dependence. 1, 7