| 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 |
|---|
| Insomnia (label). View labelExact | Typical starting dose is 5 mg once nightly immediately before bedtime, with at least 7 hours remaining before planned awakening; maximum 10 mg nightly (label). | Dual orexin receptor antagonist (DORA); orexin OX1R/OX2R antagonist. | CYP3A4 | Single-dose mean 18 h; Single-dose range 17–19 h | No | | - Next-day impairment (driving, work, falls) is assessed after initiation and dose changes; dose reduction or discontinuation may be considered when safety is compromised.
- REM intrusion symptoms (sleep paralysis, hallucinations) are screened for; discontinuation may be considered if they are distressing or dangerous.
- Interacting medications (CYP3A modulators) are reviewed, and alcohol or other CNS depressants are minimized when possible.
- Benefit is reassessed at each refill decision; ongoing use typically depends on meaningful improvement after an adequate trial.
| No | 2025-12-28 |
|---|
| Insomnia (label). View labelExact | Typical dose range is 25–50 mg once nightly within 30 minutes of bedtime, with at least 7 hours remaining before planned awakening (label). | Dual orexin receptor antagonist (DORA); orexin OX1R/OX2R antagonist. | CYP3A4 | Single-dose mean 8 h | No | | - Next-day impairment (driving, work, falls) after initiation and dose changes; if safety is compromised, dose reduction or discontinuation is commonly considered.
- REM intrusion symptoms (sleep paralysis, hallucinations); distressing or dangerous symptoms usually prompt discontinuation.
- Review interacting medications (CYP3A modulators); alcohol and other CNS depressants are generally avoided.
- Benefit at each refill decision; discontinuation is considered if insomnia does not improve after an adequate trial.
| No | 2026-03-31 |
|---|
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 |
|---|