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Expanded Table: Some Oral Drugs for Chronic Insomnia (online only)

The Medical Letter on Drugs and Therapeutics • January 9, 2023; (Issue 1667)

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View the Expanded Table: Some Oral Drugs for Chronic Insomnia

Med Lett Drugs Ther. 2023 Jan 9;65(1667):e6-10 | Show Full Introduction Hide Full Introduction

Drugs for Chronic Insomnia

The Medical Letter on Drugs and Therapeutics • January 9, 2023; (Issue 1667)

Cognitive behavioral therapy for insomnia (CBT-I) is recommended for initial treatment of chronic insomnia. CBT-I includes stimulus control, sleep education and hygiene, sleep restriction, relaxation training, and cognitive therapy. When CBT-I alone is not effective, pharmacologic treatment should be added.

Med Lett Drugs Ther. 2023 Jan 9;65(1667):1-6 | Show Full Introduction Hide Full Introduction

Daridorexant (Quviviq) for Insomnia

The Medical Letter on Drugs and Therapeutics • July 11, 2022; (Issue 1654)

The FDA has approved daridorexant (Quviviq – Idorsia), an orexin receptor antagonist, for treatment of sleep-onset and/or sleep-maintenance insomnia in adults. Daridorexant is the third orexin...

The FDA has approved daridorexant (Quviviq – Idorsia), an orexin receptor antagonist, for treatment of sleep-onset and/or sleep-maintenance insomnia in adults. Daridorexant is the third orexin receptor antagonist to be approved for this indication; suvorexant (Belsomra) and lemborexant (Dayvigo) were approved earlier.

Med Lett Drugs Ther. 2022 Jul 11;64(1654):107-10 | Show Full Introduction Hide Full Introduction

In Brief: New Benzodiazepine Warnings

The Medical Letter on Drugs and Therapeutics • November 2, 2020; (Issue 1610)

The FDA now requires boxed warnings in the package inserts of benzodiazepines describing the potential for these drugs to be abused and misused and to cause addiction and physical dependence....

The FDA now requires boxed warnings in the package inserts of benzodiazepines describing the potential for these drugs to be abused and misused and to cause addiction and physical dependence. Benzodiazepine labels have contained a boxed warning about a risk of serious drug interactions with opioids since 2016.

Med Lett Drugs Ther. 2020 Nov 2;62(1610):175 | Show Full Introduction Hide Full Introduction

Lemborexant (Dayvigo) for Insomnia

The Medical Letter on Drugs and Therapeutics • June 29, 2020; (Issue 1601)

The FDA has approved lemborexant (Dayvigo – Eisai), an orexin receptor antagonist, for treatment of sleep-onset and/or sleep-maintenance insomnia in adults. It is the second orexin receptor antagonist to...

The FDA has approved lemborexant (Dayvigo – Eisai), an orexin receptor antagonist, for treatment of sleep-onset and/or sleep-maintenance insomnia in adults. It is the second orexin receptor antagonist to be approved for this indication; suvorexant (Belsomra) was the first.

Med Lett Drugs Ther. 2020 Jun 29;62(1601):97-100 | Show Full Introduction Hide Full Introduction

Drugs for Chronic Insomnia

The Medical Letter on Drugs and Therapeutics • December 17, 2018; (Issue 1562)

Cognitive behavioral therapy for insomnia (CBT-I) is recommended for initial treatment of chronic insomnia. Pharmacologic treatment should be used in addition to CBT-I when CBT-I alone is not...

Cognitive behavioral therapy for insomnia (CBT-I) is recommended for initial treatment of chronic insomnia. Pharmacologic treatment should be used in addition to CBT-I when CBT-I alone is not effective.

Med Lett Drugs Ther. 2018 Dec 17;60(1562):201-5 | Show Full Introduction Hide Full Introduction

Expanded Table: Some Oral Hypnotics for Insomnia (online only)

The Medical Letter on Drugs and Therapeutics • December 17, 2018; (Issue 1562)

...

View the Expanded Table: Some Oral Hypnotics for Insomnia

Med Lett Drugs Ther. 2018 Dec 17;60(1562):e209-13 | Show Full Introduction Hide Full Introduction

Drugs for Insomnia

The Medical Letter on Drugs and Therapeutics • July 6, 2015; (Issue 1472)

Pharmacological treatment of insomnia includes prescription drugs, non-prescription medications, and "natural" remedies. Behavioral approaches such as cognitive behavioral therapy, which are not...

Pharmacological treatment of insomnia includes prescription drugs, non-prescription medications, and "natural" remedies. Behavioral approaches such as cognitive behavioral therapy, which are not discussed here, are also used. Pharmacologic treatment and behavioral therapy are often combined.

Med Lett Drugs Ther. 2015 Jul 6;57(1472):95-8 | Show Full Introduction Hide Full Introduction

Suvorexant (Belsomra) for Insomnia

The Medical Letter on Drugs and Therapeutics • March 2, 2015; (Issue 1463)

The FDA has approved suvorexant (Belsomra – Merck), the first orexin receptor antagonist to become available in the US, for treatment of sleep-onset and/or sleep-maintenance...

The FDA has approved suvorexant (Belsomra – Merck), the first orexin receptor antagonist to become available in the US, for treatment of sleep-onset and/or sleep-maintenance insomnia.

Med Lett Drugs Ther. 2015 Mar 2;57(1463):29-31 | Show Full Introduction Hide Full Introduction

A 4-Drug Combination (Viekira Pak) for Hepatitis C

The Medical Letter on Drugs and Therapeutics • February 2, 2015; (Issue 1461)

The FDA has approved Viekira Pak (Abbvie), a fixed-dose combination of two new direct-acting antiviral agents (ombitasvir, paritaprevir) with the pharmacologic enhancer ritonavir in one tablet, co-packaged...

The FDA has approved Viekira Pak (Abbvie), a fixed-dose combination of two new direct-acting antiviral agents (ombitasvir, paritaprevir) with the pharmacologic enhancer ritonavir in one tablet, co-packaged with a third new direct-acting antiviral agent (dasabuvir) in a second tablet, for oral treatment of chronic hepatitis C virus (HCV) genotype 1 infection. Genotype 1 is responsible for 70-80% of HCV infections in the US.

Med Lett Drugs Ther. 2015 Feb 2;57(1461):15-7 | Show Full Introduction Hide Full Introduction

Drugs for Insomnia

The Medical Letter on Drugs and Therapeutics • July 1, 2012; (Issue 119)

Pharmacological treatment of insomnia includes prescription drugs, non-prescription medications and "natural" remedies. Behavioral changes are often needed as...

Pharmacological treatment of insomnia includes prescription drugs, non-prescription medications and "natural" remedies. Behavioral changes are often needed as well.

Treat Guidel Med Lett. 2012 Jul;10(119):57-60 | Show Full Introduction Hide Full Introduction

Rufinamide (Banzel) for Epilepsy

The Medical Letter on Drugs and Therapeutics • March 9, 2009; (Issue 1307)

Rufinamide (Banzel - Eisai), a triazole derivative structurally unrelated to other marketed antiepileptic drugs (AEDs), has been approved by the FDA for treatment of seizures associated with Lennox-Gastaut...

Med Lett Drugs Ther. 2009 Mar 9;51(1307):18-20 | Show Full Introduction Hide Full Introduction

Drugs for Insomnia

The Medical Letter on Drugs and Therapeutics • March 1, 2009; (Issue 79)

The majority of patients with insomnia do not have a predisposing psychiatric disease. Rather, untreated insomnia may be a risk factor for development of psychiatric problems such as depression or...

The majority of patients with insomnia do not have a predisposing psychiatric disease. Rather, untreated insomnia may be a risk factor for development of psychiatric problems such as depression or anxiety.

Treat Guidel Med Lett. 2009 Mar;7(79):23-6 | Show Full Introduction Hide Full Introduction

Antifungal Drugs

The Medical Letter on Drugs and Therapeutics • January 1, 2008; (Issue 65)

The drugs of choice for treatment of some fungal infections are listed in the tables. Some of the indications and dosages recommended here have not been approved by the FDA. Other guidelines are available from...

Treat Guidel Med Lett. 2008 Jan;6(65):1-8 | Show Full Introduction Hide Full Introduction

Drugs for Insomnia

The Medical Letter on Drugs and Therapeutics • February 1, 2006; (Issue 42)

Many drugs are used to treat insomnia, but for some patients nonpharmacological treatments such as changing sleep habits, relaxation training and cognitive therapy may be more effective and durable than treatment with drugs. Hypnotic drugs are generally FDA-approved only for short-term use, but in practice they often are taken much longer.

Treat Guidel Med Lett. 2006 Feb;4(42):5-10 | Show Full Introduction Hide Full Introduction

Ambien CR for Insomnia

The Medical Letter on Drugs and Therapeutics • December 5, 2005; (Issue 1223)

Zolpidem (Ambien - Sanofi-Aventis), a nonbenzodiazepine benzodiazepine receptor agonist, is the most frequently prescribed hypnotic in the US. As its patent approaches expiration, its manufacturer has received...

Zolpidem (Ambien - Sanofi-Aventis), a nonbenzodiazepine benzodiazepine receptor agonist, is the most frequently prescribed hypnotic in the US. As its patent approaches expiration, its manufacturer has received FDA approval to market an extended-release formulation of the drug, Ambien CR. The pharmacological rationale for doing so is that short-acting hypnotics like zolpidem are more effective at inducing sleep than they are at maintaining it.

Med Lett Drugs Ther. 2005 Dec 5;47(1223):97-8 | Show Full Introduction Hide Full Introduction

Tipranavir (Aptivus) for HIV

The Medical Letter on Drugs and Therapeutics • October 10, 2005; (Issue 1219)

Tipranavir (Aptivus - Boehringer Ingelheim), a new protease inhibitor, has received accelerated approval from the FDA. It must be given with ritonavir (Norvir). The combination is indicated for use with other...

Tipranavir (Aptivus - Boehringer Ingelheim), a new protease inhibitor, has received accelerated approval from the FDA. It must be given with ritonavir (Norvir). The combination is indicated for use with other antiretrovirals to treat HIV infection in highly treatment-experienced adults who have ongoing viral replication or in those with HIV strains known to be resistant to multiple protease inhibitors.

Med Lett Drugs Ther. 2005 Oct 10;47(1219):83-4 | Show Full Introduction Hide Full Introduction

CYP3A and Drug Interactions

The Medical Letter on Drugs and Therapeutics • July 4, 2005; (Issue 1212)

Serious adverse interactions between drugs continue to be reported. Many of these are due to inhibition or induction of cytochrome P450 (CYP) enzymes, particularly CYP3A4. CYP3A is thought to be involved in the metabolism of more than 50 percent of currently prescribed drugs.2 CYP3A4, which is more abundantly expressed than CYP3A5, accounts for most CYP3A activity in vivo.

Med Lett Drugs Ther. 2005 Jul 4;47(1212):54-5 | Show Full Introduction Hide Full Introduction

Eszopiclone (Lunesta), a New Hypnotic

The Medical Letter on Drugs and Therapeutics • February 28, 2005; (Issue 1203)

Eszopiclone (Lunesta - Sepracor), a benzodiazepine-like drug, has been approved by the FDA for oral treatment of insomnia. It is the S-isomer of zopiclone (Imovane, and others in Canada), which has been...

Eszopiclone (Lunesta - Sepracor), a benzodiazepine-like drug, has been approved by the FDA for oral treatment of insomnia. It is the S-isomer of zopiclone (Imovane, and others in Canada), which has been available in other countries for almost 20 years. Unlike similar drugs such as zolpidem (Ambien) or zaleplon (Sonata), Lunesta is not being restricted in its labeling to short-term use. Like other hypnotics, eszopiclone is a schedule IV drug.

Med Lett Drugs Ther. 2005 Feb 28;47(1203):17-9 | Show Full Introduction Hide Full Introduction

Antifungal Drugs

The Medical Letter on Drugs and Therapeutics • February 1, 2005; (Issue 30)

The drugs of choice for treatment of some fungal infections are listed in the table that begins on page 8. Some of the indications and dosages recommended here have not been approved by the...

The drugs of choice for treatment of some fungal infections are listed in the table that begins on page 8. Some of the indications and dosages recommended here have not been approved by the FDA.

Treat Guidel Med Lett. 2005 Feb;3(30):7-14 | Show Full Introduction Hide Full Introduction

Drug Interactions with Grapefruit Juice

The Medical Letter on Drugs and Therapeutics • January 5, 2004; (Issue 1173)

The ability of grapefruit juice to increase serum concentrations of drugs was first discovered during a study of the effect of ethanol on felodipine (Plendil) pharmacokinetics. Double-strength grapefruit juice...

The ability of grapefruit juice to increase serum concentrations of drugs was first discovered during a study of the effect of ethanol on felodipine (Plendil) pharmacokinetics. Double-strength grapefruit juice used to disguise the taste of ethanol resulted in higher than expected serum concentrations of felodipine (DG Bailey et al, Clin Invest Med 1989; 12:357).

Med Lett Drugs Ther. 2004 Jan 5;46(1173):2-4 | Show Full Introduction Hide Full Introduction

Drug Interactions

The Medical Letter on Drugs and Therapeutics • June 8, 2003; (Issue 1158)

Changes caused by one drug in the absorption, distribution, metabolism or excretion of another may lead to a pharmacokinetic adverse drug interaction (DN Juurlink et al, JAMA 2003; 289:1652). Additive drug interactions, such as vasodilation caused by both sildenafil (Viagra) and nitrates, can also have adverse effects.

Med Lett Drugs Ther. 2003 Jun 8;45(1158):46-8 | Show Full Introduction Hide Full Introduction

Hypnotic Drugs

The Medical Letter on Drugs and Therapeutics • August 7, 2000; (Issue 1084)

Superseded by Drugs of Choice HandbookMany drugs are used to treat insomnia, but for some patients nonpharmacological treatments such as changing sleep habits, relaxation training and cognitive therapy may be...

Superseded by Drugs of Choice Handbook
Many drugs are used to treat insomnia, but for some patients nonpharmacological treatments such as changing sleep habits, relaxation training and cognitive therapy may be more effective than drugs.

Med Lett Drugs Ther. 2000 Aug 7;42(1084):71-2 | Show Full Introduction Hide Full Introduction

Zaleplon for Insomnia

The Medical Letter on Drugs and Therapeutics • October 8, 1999; (Issue 1063)

Zaleplon, a pyrazolopyrimidine hypnotic, was recently approved by the FDA for short-term treatment of insomia. Zaleplon, like zolpidem, is a non-benzodiazepine that binds to benzodiazepine...

Zaleplon, a pyrazolopyrimidine hypnotic, was recently approved by the FDA for short-term treatment of insomia. Zaleplon, like zolpidem, is a non-benzodiazepine that binds to benzodiazepine receptors.

Med Lett Drugs Ther. 1999 Oct 8;41(1063):93-4 | Show Full Introduction Hide Full Introduction

Amprenavir: A New HIV Protease Inhibitor

The Medical Letter on Drugs and Therapeutics • July 16, 1999; (Issue 1057)

Amprenavir is the fifth protease inhibitor to become available for treatment of HIV infection. It was approved by the FDA for use with other drugs in the treatment of HIV-infected adults and children at least...

Med Lett Drugs Ther. 1999 Jul 16;41(1057):63-6 | Show Full Introduction Hide Full Introduction

Drug Interactions

The Medical Letter on Drugs and Therapeutics • July 2, 1999; (Issue 1056)

Reports of adverse interactions between drugs continue to accumulate. Recently, the FDA has expanded the recommendations on drug interactions found in the package inserts of new...

Reports of adverse interactions between drugs continue to accumulate. Recently, the FDA has expanded the recommendations on drug interactions found in the package inserts of new drugs.

Med Lett Drugs Ther. 1999 Jul 2;41(1056):59-62 | Show Full Introduction Hide Full Introduction

Systemic Antifungal Drugs

The Medical Letter on Drugs and Therapeutics • September 12, 1997; (Issue 1009)

The drugs of choice for treatment of deep fungal infections are listed in the table below. Some of the indications and dosages recommended here have not been approved by the...

The drugs of choice for treatment of deep fungal infections are listed in the table below. Some of the indications and dosages recommended here have not been approved by the FDA.

Med Lett Drugs Ther. 1997 Sep 12;39(1009):86-8 | Show Full Introduction Hide Full Introduction

Terbinafine for Onychomycosis

The Medical Letter on Drugs and Therapeutics • August 16, 1996; (Issue 981)

Terbinafine (Lamisil - Sandoz), an allylamine synthetic antifungal, previously available in the USA in a topical formulation (Medical Letter, 35:76, 1993) has now been marketed for oral use in the treatment...

Terbinafine (Lamisil - Sandoz), an allylamine synthetic antifungal, previously available in the USA in a topical formulation (Medical Letter, 35:76, 1993) has now been marketed for oral use in the treatment of fungal nail infections caused by dermatophytes. Oral terbinafine has been available in Europe since 1992.

Med Lett Drugs Ther. 1996 Aug 16;38(981):72-4 | Show Full Introduction Hide Full Introduction

Hypnotic Drugs

The Medical Letter on Drugs and Therapeutics • July 5, 1996; (Issue 978)

Superseded by Drugs of Choice HandbookInsomnia is a commom complaint, particularly among the elderly. Many drugs are approved by the US Food and Drug Administration (FDA) for treatment of insomnia, including...

Superseded by Drugs of Choice Handbook
Insomnia is a commom complaint, particularly among the elderly. Many drugs are approved by the US Food and Drug Administration (FDA) for treatment of insomnia, including five benzodiazepines and zolpidem (Ambien), a non-benzodiazepine that binds to benzodiazepine receptors in the brain. Some drugs marketed for other indications, such as antihistamines, antidepressants and antipsychotics, are also used as hypnotics. For many patients, nonpharmacological treatment of insomnia may be more effective than drugs, especially in the long term (CM Morin et al, Am J Psychiatry, 151:1172, 1994).

Med Lett Drugs Ther. 1996 Jul 5;38(978):59-61 | Show Full Introduction Hide Full Introduction

Systemic Antifungal Drugs

The Medical Letter on Drugs and Therapeutics • February 2, 1996; (Issue 967)

The drugs of choice for treatment of deep fungal infections are listed in the table on page 101. Some of the indications and dosages recommended here have not been approved by the US Food and Drug...

The drugs of choice for treatment of deep fungal infections are listed in the table on page 101. Some of the indications and dosages recommended here have not been approved by the US Food and Drug Administration. More detailed guidelines are available from the Infectious Diseases Society of America (J Sobel et al, Clin Infect Dis, volume 30, April 2000).

Med Lett Drugs Ther. 1996 Feb 2;38(967):10-2 | Show Full Introduction Hide Full Introduction

Itraconazole for Onychomycosis

The Medical Letter on Drugs and Therapeutics • January 19, 1996; (Issue 966)

Itraconazole (Sporanox - Janssen), an oral antifungal triazole that has been available in the USA since 1992 for treatment of deep fungal infections (Medical Letter, 35:7, 1993), is now being marketed for treatment of dermatophyte infections of the toenails, with or without fingernail involvement.

Med Lett Drugs Ther. 1996 Jan 19;38(966):5-6 | Show Full Introduction Hide Full Introduction

Nefazodone for Depression

The Medical Letter on Drugs and Therapeutics • April 14, 1995; (Issue 946)

Nefazodone (Serzone - Bristol-Myers Squibb) was recently approved by the US Food and Drug Administration for treatment of depression. A phenylpiperazine, nefazodone is chemically related to trazodone...

Nefazodone (Serzone - Bristol-Myers Squibb) was recently approved by the US Food and Drug Administration for treatment of depression. A phenylpiperazine, nefazodone is chemically related to trazodone (Desyrel, and others).

Med Lett Drugs Ther. 1995 Apr 14;37(946):33-5 | Show Full Introduction Hide Full Introduction

Zolpidem For Insomnia

The Medical Letter on Drugs and Therapeutics • April 30, 1993; (Issue 895)

Zolpidem (Ambien - Searle), an imidazopyridine hypnotic available in Europe for several years, was recently approved by the US Food and Drug Administration for short-term treatment of...

Zolpidem (Ambien - Searle), an imidazopyridine hypnotic available in Europe for several years, was recently approved by the US Food and Drug Administration for short-term treatment of insomnia.

Med Lett Drugs Ther. 1993 Apr 30;35(895):35-6 | Show Full Introduction Hide Full Introduction

Estazolam - A New Benzodiazepine Hypnotic

The Medical Letter on Drugs and Therapeutics • October 4, 1991; (Issue 854)

Estazolam (ProSom - Abbott), a triazolobenzodiazepine derivative similar in structure to alprazolam (Xanax) and triazolam (Halcion), was recently marketed in the USA for treatment of...

Estazolam (ProSom - Abbott), a triazolobenzodiazepine derivative similar in structure to alprazolam (Xanax) and triazolam (Halcion), was recently marketed in the USA for treatment of insomnia.

Med Lett Drugs Ther. 1991 Oct 4;33(854):91-2 | Show Full Introduction Hide Full Introduction

Quazepam: A New Hypnotic

The Medical Letter on Drugs and Therapeutics • April 20, 1990; (Issue 816)

Quazepam (Doral - Baker Cummins, Wallace) is a trifluoroethyl benzodiazepine made by Schering and approved in 1985 by the US Food and Drug Administration for treatment of insomnia. Like other benzodiazepines,...

Quazepam (Doral - Baker Cummins, Wallace) is a trifluoroethyl benzodiazepine made by Schering and approved in 1985 by the US Food and Drug Administration for treatment of insomnia. Like other benzodiazepines, it is a Schedule IV controlled substance.Quazepam (Doral - Baker Cummins, Wallace) is a trifluoroethyl benzodiazepine made by Schering and approved in 1985 by the US Food and Drug Administration for treatment of insomnia. Like other benzodiazepines, it is a Schedule IV controlled substance.

Med Lett Drugs Ther. 1990 Apr 20;32(816):39-40 | Show Full Introduction Hide Full Introduction

Oral Hypnotic Drugs

The Medical Letter on Drugs and Therapeutics • March 10, 1989; (Issue 787)

Three benzodiazepines and 16 other compounds are marketed in the USA for treatment of insomnia. Many authorities believe that insomnia is overdiagnosed and overtreated (MK Erman, ed, Sleep Disorders,...

Med Lett Drugs Ther. 1989 Mar 10;31(787):23-4 | Show Full Introduction Hide Full Introduction

Choice of Benzodiazepines

The Medical Letter on Drugs and Therapeutics • February 26, 1988; (Issue 760)

Since The Medical Letter last reviewed the choice of benzodiazepines (Volume 23, page 41, 1981), several new drugs have been marketed and some old ones are now available generically. Most of the...

Since The Medical Letter last reviewed the choice of benzodiazepines (Volume 23, page 41, 1981), several new drugs have been marketed and some old ones are now available generically. Most of the benzodiazepines available for oral use in the USA are listed in the table on page 28.

Med Lett Drugs Ther. 1988 Feb 26;30(760):26-8 | Show Full Introduction Hide Full Introduction