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 Sleep  Holistic-online.com

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

bulletFatal overdose, especially when combined with alcohol or with other drugs that affect your central nervous system
bulletImpaired coordination, memory, driving skills, and thinking
bulletInterference with breathing
bulletPhysical or psychological dependence (unable to sleep without the medication.)
bulletTolerance (Need to take larger and larger doses to achieve the same effect.)
bulletPotential damage to kidney, liver, and lungs
bulletConfusion, hallucinations, and similar disturbances, particularly for the elderly

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