Flashcards in Drugs To Treat Insomnia Deck (35):
Before prescribing sleeping pills...
1) Cognitive behavioral therapy and sleep hygiene
2) Work-up for underlying cause
3) Sedative-Hypnotic options
Potential underlying causes of insomnia:
Substance use disorder
Psychiatric illness (mood or anxiety disorders)
Restless leg syndrome
Melatonin receptor agonists
Herbal preparations that affect GABA transmission
Will sleeping pills cure insomnia?
Can behavioral/psychological technqiues cure insomnia?
FDA approved benzodiazepines for insomnia Rx
Which FDA approved benzo is used most often to treat insomnia?
How long can benzos be used to treat insomnia?
How many days in a week can a pt use sleeping pills for insomnia?
Short term (1-3 months)
No more than 3 days/week
Which drugs should be used to treat insomnia in elderly pt?
Problems with benzos
Risk of withdrawal
Substance abuse disorder
Which patients are at the high risk of substance abuse with benzos?
Pts with other substance issues
Signs of substance abuse:
Running out of meds early, wanting a higher dose, losing meds, going to multiple doctors for prescriptions (IL PMP)
Non-benzodiazepines agonists approved for sleep disorders
"Z meds to get more zzz's"
Side effects of Non-benzo agonists
sleep walking, sleep driving, sleep eating
Relative costs of the non-benzo agonists vs. benzos
Benzos are the LEAST expensive
Zolpidem and Zaleplon are more expensive but no unreasonable
Eszopiclone is expensive
M1 & M2 melatonin receptor agonist
Down side of Ramelteon
COST- typically requires prior approval by insurance company, or trying less expensive drugs first
Sedating drugs with anti-histamineric actions: Tricyclic antidepressants
Sedating drugs with anti-histamineric actions: Mixed action antidepressants
Benefit of using antidepressants to treat insomnia
Also treat depression and anxiety, which may be the underlying cause of patient's insomnia
Sedating drugs with anti-histamineric actions: H1 histamine receptor antagonists
Of the antihistamines, which is preferred for use in the elderly?
Hydroxyzine (NOT muscarinic)
Herbal Insomnia Rx: Valeriana officinalis
sesquiterpene: mediate GABA release and inhibit GABA breakdown
No morning after hangover
No aversive effects
No serious drug interactions
Useful for 4 weeks
Herbal Insomnia Rx: Chamomile
Apigenin: benzo agonist
Herbal Insomnia Rx: Kava
Contains compounds that facilitate binding of GABA
Reported calming effects
Herbal Insomnia Rx: Passion Flower
Chrysin: a benzo partial agonist
Reported to be safe and effective (unsubstantiated)
Over the counter meds (no longer available)
Compoz (pyrilamine +methapyrilene)
Nytol (methapyrilene + salicylamide)
Sominex (methapyrilene + salicylamide + scopalamine)
Sleep-Eze (methapyrilene + scopalamine)
Produce tolerance and rebound insomnia, NOT more effective than placebo
Currently available OTC sleep aids
Buspirone site of action
5HT-1A partial agonist
short (2.5 hours)
Buspirone Side Effects
Headaches, dizziness, nervousness, sedation, nausea
DO NOT use with MAOI
Buspirone Clinical Consideration
Generalized Anxiety Disorder
C antidepressants for major depression
C antidepressants for anxiety disorders
Advantage of Buspirone vs. benzos
No risk of dependence, no withdrawal, no GABA cross tolerance
Advantage of Buspirone vs. anti-depressants
Low/no sexual side effects, weight neutral, no withdrawal