Journal of Psychosocial Nursing and Mental Health Services

Clip & Save Drug Chart 

FDA-Approved Drugs to Treat Sleep Disorders

Abstract

A handy source of up-to-date information on current medications for psychiatric illnesses

Table

A handy source of up-to-date information on current medications for psychiatric illnesses

Table

Generic (Brand) NameIndicationDrug InteractionsHabit FormingLong-Term Use
INSOMNIA
Doxepin (Silenor®)Insomnia characterized by difficulty with sleep maintenanceThe sedative effects of alcoholic beverages, sedating antihistamines, and other CNS depressants may be potentiated. Doxepin is metabolized by the hepatic cytochrome P450 enzymes CYP2C19, CYP2D6, CYP1A2, and CYP2C9. Drugs inhibiting these enzymes may increase serum concentrations of doxepin.NoClinical trials performed in support of efficacy were up to 3 months in duration.
Estazolam (ProSom®)Insomnia characterized by difficulty falling asleep, frequent nocturnal awakenings, and/or early morning awakeningsIncreased clearance and, thus, decreased esatzolam levels in smokers; increased depressive effects when taken with alcohol and other CNS depressants; inhibitors of CYP450 3A4 (e.g., nefazodone, fluvoxamine) could increase plasma levels of estazolam.Schedule IV drugaNot generally intended for long-term use.
Eszopiclone (Lunesta®)InsomniaIncreased depressive effects when taken with alcohol and other CNS depressants; inhibitors of CYP450 3A4 (e.g., nefazodone, fluvoxamine) could increase plasma levels of eszopiclone; inducers of CYP450 3A4 (e.g., carbamazepine) could decrease plasma levels of eszopiclone.Schedule IV drugaNo development of tolerance seen in studies up to 6 months.
Flurazepam (Dalmane®)Insomnia characterized by difficulty falling asleep, frequent nocturnal awakenings, and/or early morning awakenings; recurring insomnia or poor sleeping habits; acute or chronic medical situations requiring restful sleepCimetidine may decrease flurazepam clearance, thus raising flurazepam levels; combined use of flurazepam and kava may affect clearance of either drug; increased depressive effects when taken with alcohol and other CNS depressants; inhibitors of CYP450 3A4 (e.g., nefazodone, fluvoxamine) could increase plasma levels of flurazepam; inducers of CYP450 3A4 (e.g., carbamazepine) could decrease plasma levels of flurazepam.Schedule IV drugaNot generally intended for long-term use; its longer half-life may cause daytime sedation and/or impaired motor/cognitive function (possibly progressively over time).
Quazepam (Doral®)Short-term treatment of insomnia characterized by difficulty falling asleep, frequent nocturnal awakenings, and/or early morning awakeningsIncreased depressive effects when taken with alcohol and other CNS depressants; inhibitors of CYP450 3A4 (e.g., nefazodone, fluvoxamine) may increase effects of quazepam; inducers of CYP450 3A4 (e.g., carbamazepine) could decrease plasma levels of quazepam.Schedule IV drugaNot generally intended for use beyond 4 weeks; its longer half-life may cause daytime sedation and/or impaired motor/cognitive function (possibly progressively over time).
Ramelteon (Rozerem®)Insomnia (difficulty with sleep onset)Inhibitors of CYP450 1A2 (e.g., fluvoxamine) may increase plasma levels of ramelteon; inducers of CYP450 (e.g., carbamazepine) could decrease plasma levels of ramelteon; inhibitors of CYP450 3A4 (e.g., ketoconazole) could increase plasma levels of ramelteon; inhibitors of CYP450 2C9 (e.g., fluconazole) could increase plasma levels of ramelteon; use caution when combining with alcohol.NoNo reports of dependence, tolerance, or abuse liability; not restricted to short-term use, but few long-term studies exist.
Temazepam (Restoril®)Short-term treatment of insomniaIncreased depressive effects when taken with alcohol and other CNS depressants; combined use of temazepam and kava may affect clearance of either drug.Schedule IV drugaNot generally intended for long-term use.
Triazolam (Halcion®)Short-term treatment of insomniaInhibitors of CYP450 3A4 (e.g., nefazodone, fluoxetine, fluvoxamine) may decrease clearance of triazolam, thus raising levels significantly; ranitidine may increase plasma concentrations of triazolam; increased depressive effects when taken with alcohol and other CNS depressants; inducers of CYP450 3A4 (e.g., carbamazepine) could decrease plasma levels of triazolam.Schedule IV drugaNot generally intended for long-term use; increased wakefulness during the latter part of night (wearing off) or an increase in daytime anxiety (rebound) may occur.
Zaleplon (Sonata®)Short-term treatment of insomniaIncreased depressive effects when taken with alcohol and other CNS depressants; cimetidine may increase plasma concentrations of zaleplon, requiring a lower initial dosage of zaleplon (5 mg/day); inducers of CYP450 3A4 (e.g., carbamazepine) may reduce the effectiveness of zaleplon.Schedule IV drugaNot generally intended for long-term use; increased wakefulness during the latter part of night (wearing off) or an increase in daytime anxiety (rebound) may occur.
Zolpidem tartrate (Ambien®, Ambien-CR®)(Edluar® sublingual tablets)(Intermezzo® sublingual tablets)(Zolpimist® oral spray)Short-term treatment of insomnia (controlled release formula is not restricted to short-term use)Short-term treatment of insomnia characterized by difficulties with sleep initiationInsomnia characterized by middle-of-the-night waking followed by difficulty returning to sleepShort-term treatment of insomnia characterized by difficulties with sleep initiationIncreased depressive effects when taken with alcohol and other CNS depressants; sertraline may increase plasma levels of zolpidem; carbamazepine may decrease plasma levels of zolpidem.Schedule IV drugaIncreased wakefulness during the latter part of night (wearing off) or an increase in daytime anxiety (rebound) may occur.
NARCOLEPSY
Dextro-amphetamine (Dexedrine®, Dexedrine Spansules®, Dextro Stat®)Mixed amphetamine salts (Adderall®)NarcolepsyMay affect blood pressure so use cautiously with agents used to control blood pressure; GI acidifying agents (e.g., guanethidine, reserpine, glutamic acid, ascorbic acid, fruit juices) and urinary acidifying agents (e.g., ammonium chloride, sodium phosphate) decrease amphetamine plasma levels; GI alkalinizing agents (e.g., sodium barbonate) and urinary alkalinizing agents (e.g., acetazolamide) increase amphetamine plasma levels; desipramine and protryptiline can cause striking and sustained increases in brain concentrations of d-amphetamine and may add to its cardiovascular effects; theoretically, other agents with norepinephrine reuptake blocking properties (e.g., venlafaxine, duloxetine, atomoxetine, milnacipran, reboxetine) could add to amphetamine’s CNS and cardiovascular effects; amphetamines may counteract the sedative effects of antihistamines; haloperidol, chlorpromazine, and lithium may inhibit amphetamine’s stimulatory effects, theoretically, so could atypical antipsychotics. (Note. Adderall has additional potential interactions. Please see full prescribing information for details.)Schedule II drug; high abuse potential; patients may develop tolerance or psychological dependenceDependence and/or abuse may develop; some patients may develop tolerance to therapeutic effects; periodic monitoring of weight, blood pressure, complete blood count, platelet counts, and liver function may be sensible.
Methylphenidate (Metadate ER®, Methylin ER®, Ritalin®, Ritalin SR®)NarcolepsyMay affect blood pressure so use cautiously with agents used to control blood pressure; may inhibit metabolism of SSRIs, anticonvulsants, TCAs, and coumarin anticoagulants, requiring downward dosage adjustments of these drugs; combination with clonidine may cause serious adverse effects; use with MAOIs (including within 14 days of MAOI use) is not advised. (Note. Please see each agent’s full prescribing information for additional potential interactions.)Schedule II drug; high abuse potential; patients may develop tolerance or psychological dependenceDependence and/or abuse may develop; some patients may develop tolerance to therapeutic effects; periodic monitoring of weight, blood pressure, complete blood count, platelet counts, and liver function may be sensible.
Modafinil (Provigil®, Alertec®, Modiodal®)Reducing excessive sleepiness in patients with narcolepsy and shift work sleep disorder and in patients with obstructive sleep apnea/hypopnea syndromeMay increase plasma levels of drugs metabolized by CYP450 2C19 (e.g., diazepam, phenytoin, propranolol); may increase plasma levels of CYP450 2D6 substrates (e.g., TCAs, SSRIs), possibly requiring downward dosage adjustments of these agents; may decrease plasma levels of CYP450 3A4 substrates (e.g., ethinyl estradiol, triazolam); may reduce the effectiveness of steroidal contraceptives (even 1 month after modafinil discontinuation); inducers or inhibitors of CYP450 3A4 may affect modafinil levels; may slightly reduce its own levels by autoinduction of CYP450 3A4; may increase clearance of drugs dependent on CYP450 1A2 and reduce their plasma levels; methylphenidate may delay absorption of modafinil by 1 hour but co-administration does not significantly change the pharmacokinetics of either drug; patients taking modafinil and warfarin should have prothrombin times monitored.Schedule IV drug; may have some potential for abuse but unusualEffectiveness in reducing excessive sleepiness in sleep disorders has been demonstrated in 9-week to 12-week trials; need for continued treatment should be reevaluated periodically.
Sodium oxybate (Xyrem®)Treatment of cataplexy in patients with narcolepsyIncreased depressive effects when taken with alcohol, benzodiazepines, sedative-hypnotic drugs, and other CNS depressants.Schedule III drug; high risk for abuseSodium oxybate is available only through the Xyrem Success Program®, using a centralized pharmacy, with recommended follow up every 3 months.

10.3928/02793695-20120905-79

Sign up to receive

Journal E-contents