Efficacy and safety of pharmacotherapy in chronic insomnia: A review of clinical guidelines and case reports
Introduction Chronic insomnia affects 5% to 10% of the US population, increasing the demand for treatment options and the corresponding research to prove their validity.1 This review compares recommendations from 3 clinical guidelines and summarizes hypnotic medications, including their newly report...
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| Format: | Article |
| Language: | English |
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American Association of Psychiatric Pharmacists
2023-10-01
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| Series: | Mental Health Clinician |
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| Online Access: | https://theijpt.org/doi/pdf/10.9740/mhc.2023.10.244 |
| _version_ | 1797383351698456576 |
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| author | Del Rio Verduzco Alejandro PharmD, MS Salari Ahva BS Haghparast Parna PharmD, BCPS |
| author_facet | Del Rio Verduzco Alejandro PharmD, MS Salari Ahva BS Haghparast Parna PharmD, BCPS |
| author_sort | Del Rio Verduzco Alejandro PharmD, MS |
| collection | DOAJ |
| description | Introduction
Chronic insomnia affects 5% to 10% of the US population, increasing the demand for treatment options and the corresponding research to prove their validity.1 This review compares recommendations from 3 clinical guidelines and summarizes hypnotic medications, including their newly reported side effects not mentioned in the guidelines. In addition, we aim to provide an overview of what pharmacotherapies are available for prescribers and patients.
Methods
A literature search was conducted for articles published prior to January 10, 2022, and case reports and clinical studies were retrieved from PubMed and Google Scholar.
Results
Definitive conclusions cannot be drawn regarding the safety and efficacy of medications reviewed; however, trends are apparent. All 3 guidelines included in this review remarked most treatment recommendations as weak except for cognitive behavioral therapy for insomnia, which is effective but not readily available. Furthermore, based on the 15 case reports and 13 clinical studies presented in this review, many of the medications used for treatment of insomnia present safety concerns.
Discussion
Benzodiazepines and benzodiazepine receptor agonists are commonly used hypnotic agents with the “Z-drugs” having robust data establishing their efficacy for the short-term treatment of chronic insomnia. However, significant adverse effects related to the central nervous system (CNS), including developing tolerance, addiction, CNS depression, and amnesia, remain barriers to their long-term use. In comparison, newer agents present more favorable side-effect profiles although with less established efficacy. Additionally, off-label agents, including antidepressants, antihistamines, and natural supplements, are discussed due to their prominent use. |
| first_indexed | 2024-03-08T21:18:46Z |
| format | Article |
| id | doaj.art-d1d05835d60040b78556eda2953990f2 |
| institution | Directory Open Access Journal |
| issn | 2168-9709 |
| language | English |
| last_indexed | 2024-03-08T21:18:46Z |
| publishDate | 2023-10-01 |
| publisher | American Association of Psychiatric Pharmacists |
| record_format | Article |
| series | Mental Health Clinician |
| spelling | doaj.art-d1d05835d60040b78556eda2953990f22023-12-21T12:17:31ZengAmerican Association of Psychiatric PharmacistsMental Health Clinician2168-97092023-10-0113524425410.9740/mhc.2023.10.244i2168-9709-13-5-244Efficacy and safety of pharmacotherapy in chronic insomnia: A review of clinical guidelines and case reportsDel Rio Verduzco Alejandro PharmD, MS0Salari Ahva BS1Haghparast Parna PharmD, BCPS21 PGY1 Resident, Mayo Clinic Health Systems, Eau Claire, Wisconsin2 Student, University of California–San Diego, San Diego, California3 Assistant Professor and Psychiatric Pharmacist, Department of Pharmacy Practice, West Coast University School of Pharmacy, Los Angeles, California; Aurora Charter Oak Behavioral Health Center, Covina, CaliforniaIntroduction Chronic insomnia affects 5% to 10% of the US population, increasing the demand for treatment options and the corresponding research to prove their validity.1 This review compares recommendations from 3 clinical guidelines and summarizes hypnotic medications, including their newly reported side effects not mentioned in the guidelines. In addition, we aim to provide an overview of what pharmacotherapies are available for prescribers and patients. Methods A literature search was conducted for articles published prior to January 10, 2022, and case reports and clinical studies were retrieved from PubMed and Google Scholar. Results Definitive conclusions cannot be drawn regarding the safety and efficacy of medications reviewed; however, trends are apparent. All 3 guidelines included in this review remarked most treatment recommendations as weak except for cognitive behavioral therapy for insomnia, which is effective but not readily available. Furthermore, based on the 15 case reports and 13 clinical studies presented in this review, many of the medications used for treatment of insomnia present safety concerns. Discussion Benzodiazepines and benzodiazepine receptor agonists are commonly used hypnotic agents with the “Z-drugs” having robust data establishing their efficacy for the short-term treatment of chronic insomnia. However, significant adverse effects related to the central nervous system (CNS), including developing tolerance, addiction, CNS depression, and amnesia, remain barriers to their long-term use. In comparison, newer agents present more favorable side-effect profiles although with less established efficacy. Additionally, off-label agents, including antidepressants, antihistamines, and natural supplements, are discussed due to their prominent use.https://theijpt.org/doi/pdf/10.9740/mhc.2023.10.244chronic insomniazolpidemeszopiclonemelatoninramelteonsuvorexant |
| spellingShingle | Del Rio Verduzco Alejandro PharmD, MS Salari Ahva BS Haghparast Parna PharmD, BCPS Efficacy and safety of pharmacotherapy in chronic insomnia: A review of clinical guidelines and case reports Mental Health Clinician chronic insomnia zolpidem eszopiclone melatonin ramelteon suvorexant |
| title | Efficacy and safety of pharmacotherapy in chronic insomnia: A review of clinical guidelines and case reports |
| title_full | Efficacy and safety of pharmacotherapy in chronic insomnia: A review of clinical guidelines and case reports |
| title_fullStr | Efficacy and safety of pharmacotherapy in chronic insomnia: A review of clinical guidelines and case reports |
| title_full_unstemmed | Efficacy and safety of pharmacotherapy in chronic insomnia: A review of clinical guidelines and case reports |
| title_short | Efficacy and safety of pharmacotherapy in chronic insomnia: A review of clinical guidelines and case reports |
| title_sort | efficacy and safety of pharmacotherapy in chronic insomnia a review of clinical guidelines and case reports |
| topic | chronic insomnia zolpidem eszopiclone melatonin ramelteon suvorexant |
| url | https://theijpt.org/doi/pdf/10.9740/mhc.2023.10.244 |
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