| Treatment of insomnia (sleep-onset and/or maintenance) (label; product-dependent). View labelExact | Recommended initial dose is 7.5 mg at bedtime; increase to 15 mg if needed for efficacy (label). | Benzodiazepine hypnotic; GABA-A receptor positive allosteric modulator. | Hepatic metabolism (active metabolites) | Single-dose range 39–73 h | No | | - Reassess within 1–2 weeks for next-day impairment, falls, driving safety, and cognitive changes as metabolites accumulate.
- Screen for opioid co-prescribing, alcohol use, substance use risk, and sleep apnea before renewing.
- Review concurrent CNS depressants and counsel against alcohol co-use.
- If use extends beyond a brief course, document a taper plan and monitor for withdrawal symptoms.
| No | 2026-02-23 |
|---|
| Short-term treatment of insomnia (generally 7 to 10 days) (label). View labelExact | Usual adult dose: 15 mg at bedtime; some may require 30 mg (label). | Benzodiazepine hypnotic; GABA-A receptor positive allosteric modulator. | Glucuronidation | Single-dose mean 8.8 h; Single-dose range 3.5–18.4 h | No | | - Reassess insomnia diagnosis and daytime function within 1–2 weeks; discontinue if no meaningful benefit.
- Screen for opioid co-prescribing, sleep apnea/COPD, substance use risk, and fall risk before renewing.
- Monitor for next-day impairment (driving, falls), confusion, and paradoxical agitation after dose changes.
- If used beyond a short course, create and document a gradual taper plan and monitor for withdrawal.
| No | 2026-02-20 |
|---|
zolpidemAdjunctive therapyBrands: AMBIEN, AMBIEN CR | Insomnia (label). View labelExact | Take immediately before bedtime, only when able to remain in bed for a full night.
Food (especially high-fat meals) can delay onset; when rapid sleep onset is the goal, avoid taking with or immediately after a heavy meal. | Non-benzodiazepine hypnotic (“Z-drug”); GABA-A receptor positive allosteric modulator. | CYP3A4 | Single-dose mean 2.5 h; Single-dose range 1.4–4.5 h | No | | - Assess next-day impairment (driving, work, falls) after initiation and dose changes; lower the dose or stop if safety is compromised.
- Screen for complex sleep behaviors and discontinue immediately if they occur.
- Reassess for untreated sleep apnea, substance use, and mood episodes when insomnia persists rather than escalating hypnotics.
- If continued beyond a brief course, plan taper attempts and reinforce CBT-I to reduce rebound insomnia.
| No | 2025-12-28 |
|---|
| Insomnia (label). View labelExact | Typical dose is 10 mg once nightly within 30 minutes of bedtime, with at least 7 hours remaining before planned awakening; maximum 20 mg nightly (label). | Dual orexin receptor antagonist (DORA); orexin OX1R/OX2R antagonist. | CYP3A4, CYP2C19 | Single-dose mean 12 h; Single-dose range 10–22 h | No | | - Assess next-day impairment (driving, work, falls) after initiation and dose changes; lower the dose or stop if safety is compromised.
- Screen for REM intrusion symptoms (sleep paralysis, hallucinations, cataplexy-like symptoms) and discontinue if they are distressing or dangerous.
- Review interacting medications (CYP3A modulators) and avoid alcohol or other CNS depressants when possible.
- Reassess benefit at each refill decision and stop if insomnia does not improve after an adequate trial.
| No | 2025-12-28 |
|---|