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Safe medication prescribing practices for insomnia*

Safe medication prescribing practices for insomnia*
  • Prescribe the lowest possible effective dose
  • Avoid prescribing a dose greater than the maximum recommended dose
  • Avoid providing refills until continued need, efficacy, and tolerability are established
  • Avoid combining with alcohol or other sedatives, including opioids
  • Use increased caution in older adults and patients with renal and liver dysfunction
  • In patients with comorbid depression, assess for suicidal ideation before prescribing and if present, monitor closely while considering other treatment options
  • Instruct patients on proper timing of the drug in relation to desired sleep onset
  • Instruct patients on drug half-life and expected duration of effect
  • Advise against use if there is insufficient time for drug elimination between planned bedtime and rise time
  • Discuss risk of next-day impairment in alertness, memory, coordination, and driving
  • Discuss risk of complex sleep-related behaviors such as sleep walking, eating, and driving
  • Schedule regular follow-up to review efficacy, side effects, non-pharmacologic options, and assess ongoing need for medication
* For detailed prescribing information, clinicians should refer to the individual drug information topics within UpToDate. Comprehensive information on drug-drug interactions can be determined using the drug interactions tool (Lexi-Interact online). This tool can be accessed from the UpToDate online search page or through the individual drug information topics in the section on Drug interactions.
Adapted from: McCall WV, Benca RM, Rosenquist PB, et al. Hypnotic medications and suicide: Risk, mechanisms, mitigation, and the FDA. Am J Psychiatry 2017; 174:18.
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