7. Sleep disorders
Hypnotics and sedatives (for anxiolytics see section 3.1)
Hypnotics and sedatives | Preparations | Comments |
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. |
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Clomethiazole |
192mg capsules |
For use in the elderly. Not for alcohol withdrawal. |
Melatonin |
1mg, 2mg, 3mg, 4mg and 5mg tablets 2mg MR tablets 1mg/ml suspension (Ascomel - unlicensed)) |
Approved for :
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. See also lowest cost melatonin product options for the treatment of insomnia in adult and paediatric patients with learning disabilities. 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) |
Zolpidem
|
5mg and 10mg tablets |
Time to onset of action: 7 to 27 mins Short duration of action (half life 2.5 hours) |
Continue to 8.Substance dependence