Insomnia

Medications Commonly Used for the Treatment of Insomnia

Nonbenzodiazepine, selective benzodiazepine receptor agonists

Zaleplon

Common Initial Dose (half-dose is generally recommended in elderly): 10 mg
FDA Approved Maximum Daily Dose  20 mg
When: at bed time or during night 
Residual Effects - none
Withdrawal Effects and Rebound Insomnia at Abrupt Discontinuation: none

Zolpidem 
Common Initial Dose (half-dose is generally recommended in elderly) 10 mg
FDA Approved Maximum Daily Dose 10 mg
When: at bed time only
Residual Effects - minimal
Withdrawal Effects and Rebound Insomnia at Abrupt Discontinuation: minimal

Traditional benzodiazepine hypnotics

Triazolam 
Common Initial Dose (half-dose is generally recommended in elderly) 0.25 mg
FDA Approved Maximum Daily Dose 0.5 mg
When - at bedtime only 
Residual Effects - minimal to moderate
Withdrawal Effects and Rebound Insomnia at Abrupt Discontinuation: mild to severe, depending on dose, duration of use, and individual

Temazepam 
Common Initial Dose (half-dose is generally recommended in elderly) 15 mg
FDA Approved Maximum Daily Dose 30 mg
When - at bedtime only 
Residual Effects - minimal to moderate
Withdrawal Effects and Rebound Insomnia at Abrupt Discontinuation: mild to severe, depending on dose, duration of use, and individual

Flurazepam 
Common Initial Dose (half-dose is generally recommended in elderly) 15-30 mg
FDA Approved Maximum Daily Dose 30 mg
When - at bedtime only 
Residual Effects - moderate
Withdrawal Effects and Rebound Insomnia at Abrupt Discontinuation: mild to severe, depending on dose, duration of use, and individual

Anxiolytic benzodiazepines frequently used as hypnotics (off-label)

Clonazepam
Common Initial Dose (half-dose is generally recommended in elderly) 0.5 mg
FDA Approved Maximum Daily Dose 4 mg divided (for anxiety conditions) 
When - at bedtime only 
Residual Effects - moderate
Withdrawal Effects and Rebound Insomnia at Abrupt Discontinuation: mild to severe, depending on dose, duration of use, and individual

Lorazepam 
Common Initial Dose (half-dose is generally recommended in elderly) 1 mg
FDA Approved Maximum Daily Dose 6 mg divided (for anxiety conditions) 
When - at bedtime only 
Residual Effects - minimal to moderate
Withdrawal Effects and Rebound Insomnia at Abrupt Discontinuation: mild to severe, depending on dose, duration of use, and individual

Alprazolam 
Common Initial Dose (half-dose is generally recommended in elderly) 0.25 mg
FDA Approved Maximum Daily Dose 4 mg divided (for anxiety conditions) 
When - at bedtime only 
Residual Effects - minimal to moderate
Withdrawal Effects and Rebound Insomnia at Abrupt Discontinuation: mild to severe, depending on dose, duration of use, and individual

Sedating antidepressants frequently used as hypnotics (off-label)

Trazodone 
Common Initial Dose (half-dose is generally recommended in elderly) 50 mg
FDA Approved Maximum Daily Dose 400 mg divided (for depression) 
When - at bedtime only 
Residual Effects - moderate
Withdrawal Effects and Rebound Insomnia at Abrupt Discontinuation: variable

Amitriptyline 
Common Initial Dose (half-dose is generally recommended in elderly) 50 mg
FDA Approved Maximum Daily Dose 300 mg divided (for depression) 
When - at bedtime only 
Residual Effects - moderate
Withdrawal Effects and Rebound Insomnia at Abrupt Discontinuation: variable-can be a problem at higher doses

Doxepin 
Common Initial Dose (half-dose is generally recommended in elderly) 50 mg
FDA Approved Maximum Daily Dose 300 mg divided (for depression) 
When - at bedtime only
Residual Effects - moderate
Withdrawal Effects and Rebound Insomnia at Abrupt Discontinuation: variable-can be problematic at higher doses

Fluvoxamine 
Common Initial Dose (half-dose is generally recommended in elderly) 50 mg
FDA Approved Maximum Daily Dose 300 mg divided (for obsessive-compulsive disorder) 
When - at bedtime only 
Residual Effects - moderate
Withdrawal Effects and Rebound Insomnia at Abrupt Discontinuation: variable

Mirtazapine 
Common Initial Dose (half-dose is generally recommended in elderly) 15 mg
FDA Approved Maximum Daily Dose 45 mg (for depressions) 
When - at bedtime only 
Residual Effects - moderate
Withdrawal Effects and Rebound Insomnia at Abrupt Discontinuation: variable

Nefazodone 
Common Initial Dose (half-dose is generally recommended in elderly) 100 mg
FDA Approved Maximum Daily Dose 600 mg divided (for depressions) 
When - at bedtime only 
Residual Effects - minimal to moderate
Withdrawal Effects and Rebound Insomnia at Abrupt Discontinuation: variable

Other sedating agents

Diphenhydramine 
Common Initial Dose (half-dose is generally recommended in elderly) 25 mg
FDA Approved Maximum Daily Dose 100 mg
When - at bedtime only 
Residual Effects - minimal to moderate
Withdrawal Effects and Rebound Insomnia at Abrupt Discontinuation: minimal

Gabapentin 
Common Initial Dose (half-dose is generally recommended in elderly) 300 mg
FDA Approved Maximum Daily Dose 1800 mg divided (for seizures) 
When - at bedtime only 
Residual Effects - minimal to moderate
Withdrawal Effects and Rebound Insomnia at Abrupt Discontinuation: variable

OTC Sleep-Promoting Drugs

Examples of OTC sleep-promoting drugs are the use of sedating antihistamines alone or in combination with analgesics.

Common Side Effects Of Prescription Or Over-The-Counter Sleep Aids

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