Drug regimens for insomnia

If a drug is considered necessary to treat insomnia in an adult, consider factors influencing drug choice and use:

1 temazepam 10 to 20 mg orally, 30 minutes before bedtime for the shortest possible duration; preferably not on consecutive nights and for less than 2 weeks. Start at the lower end of the dose range for older or frail patients. See Hypnotics for principles of use insomnia temazepam temazepam temazepam

OR

1 zolpidem modified-release 6.25 to 12.5 mg orally, at bedtime for the shortest possible duration; preferably not on consecutive nights and for less than 2 weeks. Start at the lower end of the dose range for older or frail patients. See Hypnotics for principles of use¹ insomnia zolpidem zolpidem zolpidem

OR

1 zolpidem immediate-release 5 to 10 mg orally, at bedtime for the shortest possible duration; preferably not on consecutive nights and for less than 2 weeks. Start at the lower end of the dose range for older or frail patients. See Hypnotics for principles of use¹ zolpidem zolpidem zolpidem

OR

1 zopiclone 3.75 to 7.5 mg orally, at bedtime for the shortest possible duration; preferably not on consecutive nights and for less than 2 weeks. Start at the lower end of the dose range for older or frail patients. See Hypnotics for principles of use insomnia zopiclone zopiclone zopiclone

OR

2 melatonin modified-release 2 mg orally, 60 to 120 minutes before bedtime for an initial period of 3 weeks then review. Melatonin may be continued for an additional 10 weeks. See Melatonin for further information insomnia melatonin melatonin melatonin

OR

2 melatonin immediate-release 0.5 to 3 mg orally, at bedtime for an initial period of 3 weeks then review. Melatonin may be continued for an additional 10 weeks. See Melatonin for further information² ³ melatonin melatonin melatonin

OR

3 suvorexant 20 mg orally (adult 65 years or older: 15 mg), 30 minutes before bedtime and at least 7 hours before the patient plans to get up. Take for up to 3 months then review. See Suvorexant for further information. insomnia suvorexant suvorexant suvorexant

¹ The United States Food and Drugs Administration (FDA) recommends using the dose at the lower end of the range for females because of increased risk of an elevated morning zolpidem concentration, which may impair driving.Return

² Avoid using internet-sourced melatonin formulations—the melatonin content in these preparations is unreliable.Return

³ A low melatonin dose (eg 0.5 mg) closely resembles physiological release.Return