FDA-approved sedative-hypnotics
Flurazepam
Quazepam
Triazolam
Estazolam
Temazepam
Pitfalls
- 1.
Prescribing for pregnant patients.
- 2.
Prescribing for poorly treated patients with sleep apnea.
- 3.
Prescribing for patients with history of substance abuse.
- 4.
Patients with underlying renal, hepatic, cardiac, or pulmonary disease have a higher risk of side effects and must be monitored more closely.
- (a)
Includes respiratory depression in those predisposed
- (a)
- 5.
Withdrawal effects may present within a few hours of discontinuing a short-acting medication.
- (a)
Symptoms include anxiety, depression, rebound insomnia, and nausea.
- (a)
25.7.2 Antidepressants
These typically can be prescribed for those patients with insomnia that is associated with a psychiatric disorder [7]. Furthermore, in those patients with a history of substance abuse, consideration may be given to prescribing a short course of this class of medication, in consultation with the patient’s primary care physician or psychiatrist, though it is important to remember that there is limited evidence for the effectiveness of treating insomnia in depressed patients [8].
Some antidepressants used for treatment of insomnia |
|---|
Amitriptyline |
Trazodone |
Mirtazapine |
Pitfalls
- 1.
Have anticholinergic effects, beware of overdose
- 2.
Have the effect of increased morning sedation
- 3.
May have cardiac toxicity in overdose
- 4.
