Sleep Disorders: Treatments

SLEEP DISORDERS: TREATMENTS
Generic Brand Strength Form Dose1 Notes
INSOMNIA
doxepin Silenor Rx 3mg, 6mg tabs Adults: Initially 6mg once daily; max: 6mg/day. Elderly, hepatic impairment, tendency to urinary retention: initially 3mg once daily.
Children: Not recommended.
Take within 30mins of bedtime. Do not take within 3hrs of a meal.
eszopiclone Lunesta CIV 1mg, 2mg, 3mg tabs Adults: Initially 1mg; may increase to 2–3mg if needed; max 3mg/dose. Elderly, debilitated, concomitant CYP3A4 inhibitors, or severe hepatic impairment: max 2mg/dose.
Children: <18yrs: Not established.
Effects delayed if taken with or after a heavy/ high-fat meal. Take immediately before bedtime (with ≥7–8hrs remaining before planned time of awakening).
estazolam CIV 1mg+, 2mg+ tabs Adults: Initially 1mg at bedtime; may increase to 2mg nightly. Small or debilitated elderly: initially 0.5mg.
Children: <18yrs: Not recommended.
flurazepam CIV 15mg, 30mg caps Adults: 15–30mg at bedtime. Elderly or debilitated: initially 15mg at bedtime.
Children: <15yrs: Not recommended.
lemborexant Dayvigo CIV 5mg, 10mg tabs Adults: 5mg once per night; may increase to max 10mg/day based on clinical response and tolerability. Concomitant weak CYP3A inhibitors, moderate hepatic impairment: max 5mg/day.
Children: Not established.
Effect may be delayed if taken with or soon after a meal. Take immediately before bedtime, with (≥7hrs) remaining before the planned time of awakening.
quazepam Doral CIV 15mg+ tabs Adults: Initially 7.5mg at bedtime; may increase to 15mg if needed.
Children: Not established.
ramelteon Rozerem Rx 8mg tabs Adults: Take 8mg within 30mins of bedtime.
Children: Not recommended.
Do not take with high-fat/heavy meals (delays effect).
suvorexant Belsomra CIV 5mg, 10mg, 15mg, 20mg tabs Adults: 10mg once per night; may increase if ineffective; max 20mg/day. Concomitant moderate CYP3A inhibitors: 5mg; max 10mg/day.
Children: Not established.
Effect may be delayed if taken with or soon after a meal. Take within 30mins of bedtime if able to get full night’s sleep (≥7hrs) before awakening.
temazepam Restoril CIV 7.5mg, 15mg, 22.5mg, 30mg caps Adults: Usual dose: 7.5mg–30mg at bedtime. Elderly or debilitated: initially 7.5mg.
Children: Not established.
triazolam Halcion CIV 0.25mg+ tabs Adults: 0.125–0.25mg at bedtime; max 0.5mg. Elderly: initially 0.125mg; max 0.25mg.
Children: Not established.
Reevaluate if used ≥3wks.
zaleplon Sonata CIV 5mg, 10mg caps2 Adults: 10mg; max 20mg. Mild to moderate hepatic impairment, concomitant cimetidine, or low weight patients: 5mg. Elderly, debilitated: 5mg; max 10mg.
Children: Not established.
Effects delayed if taken with or after a heavy/ high-fat meal. Take immediately prior to bedtime or after patient has gone to bed and experienced difficulty falling asleep (with ≥7–8hrs of sleep remaining).
zolpidem tartrate Ambien CIV 5mg, 10mg tabs Adults: Women: initially 5mg. Men: initially 5mg or 10mg. Both: if 5mg ineffective, may increase to max 10mg. Elderly, debilitated, or mild to moderate hepatic impairment: 5mg.
Children: <18yrs: Not recommended.
Effects delayed if taken with or after a meal. Take once per night immediately before bedtime (with ≥7–8hrs remaining before planned time of awakening).
Ambien CR CIV 6.25mg, 12.5mg ext-rel tabs Adults: Women: initially 6.25mg. Men: initially 6.25mg or 12.5mg. Both: if 6.25mg ineffective, may increase to max 12.5mg. Elderly, debilitated, or mild to moderate hepatic impairment: 6.25mg.
Children: <18yrs: Not recommended.
Edluar CIV 5mg, 10mg SL tabs Adults: Place 1 tab under the tongue and allow to dissolve; do not take with water. Women: initially 5mg. Men: initially 5mg or 10mg. Both: if 5mg ineffective, may increase to max 10mg. Elderly, debilitated, or hepatic impairment: 5mg.
Children: <18yrs: Not recommended.
Intermezzo CIV 1.75mg, 3.5mg SL tabs Adults: Place 1 tab under the tongue and allow to disintegrate completely before swallowing. Women: 1.75mg. Men: 3.5mg. Concomitant CNS depressants, elderly (≥65yrs), hepatic impairment: 1.75mg.
Children: <18yrs: Not recommended.
Effects delayed if taken with or after a meal. Take only once per night as needed (with ≥4hrs of bedtime remaining before planned time of waking).
Zolpimist CIV 5mg/spray oral soln spray Adults: Women: initially 5mg (1 actuation). Men: initially 5mg or 10mg (2 actuations). Both: if 5mg ineffective, may increase to max 10mg. Elderly, debilitated, or hepatic impairment: 5mg.
Children: <18yrs: Not recommended.
Effects delayed if taken with or after a meal. Take once per night immediately before bedtime (with ≥7–8hrs remaining before planned time of awakening).
NARCOLEPSY
amphetamine sulfate Evekeo CII 5mg, 10mg tabs Adults and Children: <6yrs: Not recommended. Usual range 5–60mg/day.
6–12yrs: initially 5mg daily, may increase by 5mg/day at weekly intervals.
≥12yrs: initially 10mg daily; may increase by 10mg/day at weekly intervals.
Give first dose upon awakening and additional doses at 4–6hr intervals.
armodafinil Nuvigil CIV 50mg, 150mg, 200mg, 250mg tabs Adults: ≥17yrs: 150mg or 250mg once daily in the AM.
Children: <17yrs: Not recommended.
dextro
amphetamine sulfate
CII 5mg+, 10mg+ tabs Adults: 5–60mg daily in divided doses.
Children: <6yrs: Not recommended.
6–12yrs:
initially 5mg daily; may increase by 5mg/day at weekly intervals.
≥12yrs: initially 10mg daily; may increase by 10mg/day at weekly intervals.
Avoid late evening doses. Give first dose upon awakening and 1–2 more doses 4–6hrs apart.
Dexedrine Spansule CII 5mg, 10mg, 15mg sust-rel caps
Zenzedi CII 2.5mg, 5mg, 7.5mg, 10mg, 15mg, 20mg, 30mg tabs
methylphenidate HCl CII 5mg, 10mg+, 20mg+ tabs Adults: 10–60mg daily in 2–3 divided doses preferably 30–45mins before meals. Chew tabs: take with 8oz of water or other fluid.
Children: <6yrs: Not established. ≥6yrs: initially 5mg twice a day before breakfast and lunch. Increase gradually by 5–10mg per week if needed; max 60mg daily.
May use methylphenidate ER tabs (max 60mg/day) in place of IR tabs when the 8-hr dose of methylphenidate ER corresponds to the titrated 8-hr dose of the IR.
2.5mg, 5mg, 10mg chew tabs3
Methylin Oral Solution CII 5mg/5mL, 10mg/5mL oral soln
Ritalin CII 5mg, 10mg+, 20mg+ tabs Adults: Give in 2–3 divided doses preferably 30–45mins before meals. Usual dose: 20–30mg/day; max 60mg/day.
Children: <6yrs: Not established. ≥6yrs: initially 5mg twice daily before breakfast and lunch. May increase by 5–10mg weekly; max 60mg/day.
mixed dextroamphetamine/ amphetamine salts CII 5mg, 7.5mg, 10mg, 12.5mg, 15mg, 20mg, 30mg double-scored tabs Adults and Children: <12yrs: use dextroamphetamine sulfate. ≥12yrs: Usual range 5–60mg/day in divided doses. Avoid late evening doses; give upon awakening and 4–6hrs apart.
modafinil Provigil CIV 100mg, 200mg+ tabs Adults: ≥17yrs: 200mg once daily in the AM; max 400mg/day. Severe hepatic impairment: 100mg once daily.
Children: <17yrs: Not established.
pitolisant Wakix Rx 4.45mg, 17.8mg tabs Adults: Week 1: initially 8.9mg once daily; Week 2: increase to 17.8mg once daily; Week 3: may increase to max 35.6mg once daily. Adjust dose based on tolerability.
Children: Not established.
Take in the AM upon awakening.
sodium oxybate Xyrem CIII 500mg/mL soln Adults: Initially 4.5g/night in 2 equally divided doses, at bedtime then again 2.5–4hrs later. May increase by 1.5g/night (0.75g/dose) at weekly intervals; usual range: 6–9g/night; max 9g/night.
Children: <7yrs: Not established.
≥7yrs (20–<30kg):
initially ≤2g/night in 2 equally divided doses, at bedtime then again 2.5–4hrs later. May increase by 1g/night (0.5g/dose) at weekly intervals. Max total dose: 6g/night.
(30–<45kg): initially ≤3g/night in 2 equally divided doses, at bedtime then again 2.5–4hrs later. May increase by 1g/night (0.5g/dose) at weekly intervals. Max total dose: 7.5g/night.
(≥45kg): initially ≤4.5g/night in 2 equally divided doses, at bedtime then again 2.5–4hrs later. May increase by 1.5g/night (0.75g/dose) at weekly intervals; max total dose: 9g/night.
Take on empty stomach. Dilute each dose with 60mL of water. Allow 6hrs before becoming active after last dose.
solriamfetol Sunosi CIV 75mg+, 150mg tabs Adults: Initially 75mg once daily; usual range 75–150mg/day. May double dose at intervals of ≥3 days; max 150mg/day. Renal impairment: CrCl 30–59mL/min: initially 37.5mg/day; may increase to max 75mg/day after ≥7 days. CrCl 15–29mL/min: initially and at max 37.5mg/day. CrCl <15mL/min: not recommended.
Children: Not established.
Take upon awakening; avoid within 9hrs of planned bedtime.
NON-24-HOUR
tasimelteon Hetlioz Rx 20mg caps Adults: 20mg once daily before bedtime.
Children: Not established.
Take at the same time every night. Avoid with food.
RESTLESS LEG SYNDROME
gabapentin enacarbil Horizant Rx 300mg, 600mg ext-rel tabs Adults: 600mg once daily at about 5pm with food. No additional benefit with 1200mg. Renal impairment: CrCl 30–59mL/min: initially 300mg/day and increase to 600mg as needed. CrCl 15–29mL/min: 300mg/day. CrCl <15mL/min: 300mg every other day. CrCl <15mL/min on HD: not recommended.
Children: Not studied.
If dose not taken at recommended time, next dose should be taken the following day.
pramipexole Mirapex Rx 0.125mg, 0.25mg+, 0.5mg+, 0.75mg, 1mg+, 1.5mg+ tabs Adults: Initially 0.125mg once daily 2–3 hrs before bedtime. May double dose every 4–7 days; max 0.5mg/day (doses of 0.75mg/day have been used). Renal impairment: increase titration interval to every 14 days if needed.
Children: Not established.
ropinirole Requip Rx 0.25mg, 0.5mg, 1mg, 2mg, 3mg, 4mg, 5mg tabs Adults: Initially 0.25mg on Days 1 & 2, then 0.5mg on Days 3–7, increase by 0.5mg/day at 1-wk intervals to 3mg then may increase to 4mg after 1wk; max 4mg/day. ESRD on HD: initially 0.25mg/day; max 3mg/day.
Children: Not established.
Take once-daily 1–3 hrs before bedtime. Titrate gradually.
NOTES

Key: + = scored; ER = extended-release; HD = hemodialysis; IR = intermediate-release; SL = sublingual

1 Use lowest effective dose

2 Contains tartrazine

3 Contains phenylalanine

Not an inclusive list of medications, official indications, or dosing information. Please see drug monograph at www.eMPR.com and/or contact company for full drug labeling.

Created 6/2020

This article originally appeared on MPR