zaleplonAdjunctive therapyBrands: SONATA | Insomnia (label). View labelExact | Recommended dose is 10 mg immediately before bedtime or after going to bed and having difficulty falling asleep; elderly/debilitated patients generally use 5 mg (label). | Non-benzodiazepine hypnotic (“Z-drug”); GABA-A receptor positive allosteric modulator. | Aldehyde oxidase, CYP3A4 | Single-dose mean 1 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 |
|---|
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 | Typically taken immediately before bedtime, when able to remain in bed for a full night.
Food can delay onset; when delayed onset is a concern, bedtime dosing is often separated from heavy meals. “Middle of the night” redosing is generally avoided. | Non-benzodiazepine hypnotic (“Z-drug”); GABA-A receptor positive allosteric modulator. | CYP3A4, CYP2E1 | Single-dose mean 6 h | No | | - Next-day impairment (driving, work, falls) after initiation and dose changes; dosing is adjusted or discontinued if safety is compromised.
- Complex sleep behaviors; when they occur, discontinuation is typical.
- Mood and suicidality in patients with depression or serious mental illness.
- If continued beyond a brief course, taper attempts and CBT-I reinforcement to reduce rebound insomnia.
| No | 2025-12-28 |
|---|
| Insomnia (label). View labelExact | Take 8 mg within 30 minutes of bedtime (label). | Melatonin receptor agonist (MT1/MT2); hypnotic for sleep onset insomnia. | CYP1A2, CYP3A4, CYP2C9 | Single-dose mean 1.5 h; Single-dose range 1–2.6 h | No | | - Reassess sleep latency and next-day functioning within a few weeks; stop if benefit is minimal rather than escalating.
- Review interacting medications (especially CYP1A2 inhibitors/inducers) and timing with meals when response changes.
- Monitor mood and suicidality in patients with depression or mood instability when insomnia is part of a mood episode.
- Reinforce CBT-I and sleep hygiene and address sleep apnea/substance use when insomnia persists.
| No | 2026-03-31 |
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