Pharmacological treatment of insomnia

Introduction
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By Natalie Cornay MD and Hrayr P Attarian MD

Drs. Cornay and Attarian of Northwestern University in Chicago, Illinois, review all the pharmacological means for the treatment of insomnia. This review includes information on benzodiazepines, nonbenzodiazepine hypnotics, antidepressants, herbal supplements including melatonin, and other over-the-counter medications. Also included is a review of the newly FDA-approved class of drugs, orexin receptor antagonists, as well as future developments.

Key Points

  • Pharmacological treatment of insomnia is an important therapeutic field that can significantly improve health and quality of life in patients with problems falling or staying asleep.
  • So far, the most effective medications have been the GABAA agonists, either benzodiazepines or benzodiazepine receptor agonists.
  • Certain antidepressants, melatonin agonists, and other non-GABA agonist medications may have a modest role in the treatment of insomnia.
  • The orexin receptor antagonist suvorexant has just been approved by the FDA for use in insomnia.
  • Future medications will likely be 5-HT2A receptor antagonists and neurokinin 1 receptor antagonists.

In This Article

Introduction
Historical note and nomenclature
Scientific basis
Indications
Contraindications
Goals and endpoint
Description
Outcome
Adverse effects
Prognosis
Clinical vignette
Pregnancy
References cited
Contributors