federal government websites often end in .gov or .mil. the site is secure. chronic insomnia affects 57% of the elderly in the united states, with impairment of quality of life, function, and health. the main modalities in the treatment of insomnia in the elderly are psychological/behavioral therapies, pharmacological treatment, or a combination of both. pharmacotherapy plays an adjunctive role when insomnia symptoms persist or when patients are unable to pursue cognitive behavioral therapies. this review focuses on food and drug administration (fda)-approved drugs for insomnia, including suvorexant, low-dose doxepin, z-drugs (eszopiclone, zolpidem, zaleplon), benzodiazepines (triazolam, temazepam), and ramelteon. we review the indications, dosing, efficacy, benefits, and harms of these drugs in the elderly, and discuss data on drugs that are commonly used off-label to treat insomnia, and those that are in clinical development.
suvorexant or low-dose doxepin can improve sleep maintenance. eszopiclone or zolpidem extended release can be utilized for both sleep onset and sleep maintenance. trazodone, a commonly used off-label drug for insomnia, improves sleep quality and sleep continuity but carries significant risks. tiagabine, sometimes used off-label for insomnia, is not effective and should not be utilized. tryptophan decreases sleep onset in adults, but data in the elderly are not available. phase ii studies of dual orexin receptor antagonists (almorexant, lemborexant, and filorexant) have shown some improvement in sleep maintenance and sleep continuity. histamine receptor inverse agonists (apd-125, eplivanserin, and ly2624803) improve slow-wave sleep but, for various reasons, the drug companies withdrew their products.
because of their access to the general public and expertise in drug therapy, pharmacists are uniquely qualified to assist patients with insomnia. the pharmacist may be the initial point of contact for patients with insomnia, and they can provide referrals to physicians. antihistamines such as diphenhydramine (e.g., benadryl) and doxylamine (e.g., unisom) are widely available otc, but should be used with caution in the elderly. pharmacist-to-patient counseling tips: owing to the widespread availability and marketing of the aforementioned nutraceuticals for insomnia to the general public, their use often is not supervised by pharmacists. the use of herbs and supplements for chronic insomnia that is not medically supervised should be discouraged because an underlying, treatable cause of insomnia may otherwise be masked. the pharmacist should counsel patients to restrict their intake of alcohol and other cns depressants concurrently with benzodiazepines. because trazodone has essentially no potential for addiction and limited potential for abuse, it may be preferred to benzodiazepines in patients with a history of substance abuse. finally, the pharmacist should promote principles of good sleep hygiene and take a thorough medication history to rule out any iatrogenic causes of the insomnia.
the use of non-prescription sleep products in the elderly. 8. kudo y, kurihara m. clinical evaluation of diphenhydramine hydrochloride for the treatment of insomnia in psychiatric patients: a double-blind study. the biological activity of valerian and related plants. 18. wheatley d. medicinal plants for insomnia: a review of their pharmacology, efficacy and tolerability. study of antimicrobial activity of chamomile oil. melatonin improves sleep quality of patients with chronic schizophrenia. safe and effective therapy for sleep problems in the older patient. doxepin in the treatment of primary insomnia: a placebo-controlled, double-blind, polysomnographic study. the effects of doxepin hcl on sleep and depression.
ramelteon or short-acting z-drugs can treat sleep-onset insomnia. suvorexant or low-dose doxepin can improve sleep maintenance. eszopiclone or zolpidem extended there are several nonpharmacological options for the treatment of insomnia, including relaxation techniques, improving sleep hygiene, and psychological and behavioral interventions are effective in older adults, according to the 2008 aasm guideline. a 16-week randomized, controlled trial by reid, safe sleeping pills for elderly, safe sleeping pills for elderly, natural remedies for insomnia in elderly, sleep elderly treatment, what is best sleeping pill for elderly.
eszopiclone was recently approved by the food and drug administration for the treatment of insomnia. its dose in the elderly is 1 to 2 mg. ramelteon, a in the elderly, nonbenzodiazepines such as zolpidem, eszopiclone, zaleplon, and ramelteon are safer and better tolerated than tricyclic treatment for insomnia in older adults stimulus control: this technique is rooted in the idea that patients should only go to bed when they are, what is the drug you will give for a elderly patient with difficulty sleeping, drugs that cause insomnia in elderly.
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