III. Adverse Effects

IV. Precautions

  1. Avoid in over age 65 years old (See Beers List)
  2. These agents have a duration of effect that extends past the time patients awaken
  3. Long acting agents (e.g. Eszopiclone or Lunesta)
    1. Full dose can impair driving, coordination and memory for up to 11 hours
  4. Since 2013 FDA has moved to lower the maximum doses in women and older patients
    1. Also cautioned about the hang over effect in all patients
  5. FDA Warning
    1. http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm101557.htm

V. Pharmacokinetics

  1. All are metabolized by CYP450 3A4

VI. Drug Interactions

  1. Alcohol and other CNS depressants have additive effect
  2. Narcotic concurrent use may cause excess Sedation

VII. Advantages

  1. Less Anticholinergic affect than other hypnotics
  2. Low addictive potential compared with Benzodiazepines
  3. Minimal effect on Sleep Stages
  4. Lack of withdrawal side effects
  5. No rebound Insomnia
  6. Little or no tolerance, effective to 1 year

VIII. Disadvantages

  1. Non-pharmacologic therapy for Insomnia (e.g. CBT-I) has better longterm outcomes

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