eszopiclone (Lunesta)
zaleplon (Sonata)
zolpidem (Ambien)
Medication side effects
Sedative-hypnotics - Side effects of sedative-hypnotics can include: Residual daytime sedation, cognitive impairment, motor incoordination, headache, dizziness, nausea, abdominal pain, respiratory suppression, they may be habit forming with long-term use, and they can cause rebound insomnia on discontinuance. A less common side effect of zolpidem involves inappropriate behaviors while not fully awake (e.g., sleep walking, driving, making telephone calls, eating, or having sex).
zolpidem (Ambien)
https://en.wikipedia.org/wiki/Zolpidem
https://www.drugs.com/zolpidem.html
https://medlineplus.gov/druginfo/meds/a693025.html
Dosage forms:
oral capsule (7.5 mg)
oral tablet (10 mg; 5 mg)
oral tablet, extended release (12.5 mg; 6.25 mg)
sublingual tablet (1.75 mg; 3.5 mg; 5 mg; 10 mg)
Watson, N. F., Benca, R. M., Krystal, A. D., McCall, W. V., & Neubauer, D. N. (2023). Alliance for Sleep Clinical Practice Guideline on Switching or Deprescribing Hypnotic Medications for Insomnia. Journal of clinical medicine, 12(7), 2493. https://doi.org/10.3390/jcm12072493. Full text: https://pmc.ncbi.nlm.nih.gov/articles/PMC10095217/pdf/jcm-12-02493.pdf
An evidence-based clinical practice guideline (systematic review; used GRADE approach) from the Family Physicians of Canada on deprescribing BzRAs for insomnia recommended that deprescribing (slow tapering) should be offered to all adults > 65 years old
regardless of duration of use and suggested to adults 18–64 who have used benzodiazepine
receptor agonists > 4 weeks. The recommendations are applicable to individuals with
primary insomnia and to those with comorbid insomnia whose underlying comorbidities
are effectively managed [50].
Another systematic review of interventions to deprescribe BZDs and other hypnotics
in older adults (>65 years; seven studies) reported that pharmacological substitution
or tapering with psychological support was more effective than patient education with
tapering, and that deprescribing did not lead to an increase in withdrawal symptoms or a
decrease in sleep quality [51]. A systematic review of BZD discontinuation in older adults
with insomnia, anxiety, or depression found that all modalities of discontinuation (taper
alone, taper plus cognitive behavioral therapy, taper plus medication substitution) were
effective, and results were independent of dose or duration of hypnotic use [52].
A systematic review and meta-analysis of psychosocial interventions for BZD hypnotic
discontinuation (eight studies in the meta-analysis) found that short-term (<3 mos) CBT-I
plus gradual tapering was more effective than gradual tapering alone for discontinuation,
but there was no difference in long-term efficacy of CBT-I at 12 months [53]