7. Sleep disorders

Hypnotics should be prescribed for short term user only and avoided in the elderly as they are at increased risk of becoming ataxic and confused leading to falls and injury. When hypnotics are used in the elderly lower starting doses should be used as elimination half life is significantly increased in this group and can lead to accumulation.

Clomethiazole

192mg capsules

For use in the elderly. Not for alcohol withdrawal.

Melatonin

2mg MR tablets

1mg, 2mg, 3mg, 4mg and 5mg tablets (Adaflex)

3mg tablets (Ceyesto)

1mg/ml oral solution (Ceyesto)                                                

Approved for :

• Insomnia and sleep cycle dysregualtion in patients under 18 years of age with ASD or ADHD. To be initiated and stabilised by specialists and then continued in primary care in line with the prescribing support document.

• Insomnia in children and adults with a learning disability who are under specialist care (e.g. a paediatrician, psychiatrist or a specialist involved in the patient’s care). To be initiated and stabilised by specialists and then continued in primary care in line with the prescribing support document.

Prescribing support documents provide details on appropriate initiation, prescribing, monitoring and ongoing prescribing in primary care.

Product choice should be based on the most cost-effective and most clinically suitable product. Generic melatonin 2mg M/R tablets are first line choice. Immediate-release melatonin tablets may be considered when an immediate release preparation is preferred:See lowest cost melatonin product options for

 treatment of insomnia in adult and paediatric patients with learning disabilities. 

treatment of insomnia in neurodevelopmental disorders in patients aged 2 to 18 years 

Note: not all preparations are licensed for the above approved indication /age groups and will be considered off label use.    

NOT approved for other indications.

Promethazine hydrochloride

10mg and 25mg tablets 

25mg/5ml oral liquid    

25mg/ml injection

Clinically significant anticholinergic side-effects.

Time to onset of action 1-2 hours. Long duration of action (half life 16 -19 hours)

Injection for HPFT prescribing only

Temazepam

10mg and 20mg tablets               

10mg/5ml oral solution

Benzodiazepines should be used to treat insomnia only when it is severe, disabling, or causing the patient extreme distress. 

Time to onset of action: 30 to 60 mins.

Medium duration of action (half life 8 – 10 hours)     

Treated as full controlled drug within HPFT.

Zopiclone

3.75mg and 7.5mg tablets

Time to onset: 15 to 30mins of action.     

Short duration of action (half life 3.5 - 6 hours)

NICE TA77

Zolpidem

5mg and 10mg tablets

Time to onset of action: 7 to 27 mins

Short duration of action (half life 2.5 hours)

 NICE TA77