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Insomnia: A Therapeutic Review for Pharmacists
OBJECTIVE: To review the literature for the management of insomnia.
DATA SOURCE: MEDLINE/PUBMED searches (January 1950-June 2010) were conducted to identify pertinent English-language studies.
STUDY SELECTION AND DATA EXTRACTION: All studies evaluating aspects of the treatment of insomnia.
DATA SYNTHESIS: Insomnia is a major public health problem requiring effective diagnosis and treatment. Treatment options include cognitive behavioral therapy as well as pharmacologic therapy. Benzodiazepine receptoragonist modulators are considered first-line therapy in the treatment of chronic insomnia. A nonbenzodiazepine receptor-modulator option to improve sleep latency is ramelteon. Low-dose sedative antidepressants, such as quetiapine or olanzapine, may be used in the treatment of comorbid insomnia. Over-the-counter and herbal agents are not recommended.
CONCLUSION: Numerous medications being used in the management of insomnia have side effects that can limit their use and have a potential for drug interactions. Furthermore, some medications used in the treatment of insomnia do not have clinical trial data to support their use. Future studies are warranted to define second- and third-line agents in the management of insomnia.
DATA SOURCE: MEDLINE/PUBMED searches (January 1950-June 2010) were conducted to identify pertinent English-language studies.
STUDY SELECTION AND DATA EXTRACTION: All studies evaluating aspects of the treatment of insomnia.
DATA SYNTHESIS: Insomnia is a major public health problem requiring effective diagnosis and treatment. Treatment options include cognitive behavioral therapy as well as pharmacologic therapy. Benzodiazepine receptoragonist modulators are considered first-line therapy in the treatment of chronic insomnia. A nonbenzodiazepine receptor-modulator option to improve sleep latency is ramelteon. Low-dose sedative antidepressants, such as quetiapine or olanzapine, may be used in the treatment of comorbid insomnia. Over-the-counter and herbal agents are not recommended.
CONCLUSION: Numerous medications being used in the management of insomnia have side effects that can limit their use and have a potential for drug interactions. Furthermore, some medications used in the treatment of insomnia do not have clinical trial data to support their use. Future studies are warranted to define second- and third-line agents in the management of insomnia.
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Keywords: Benzodiazepine; Cognitive behavioral therapy; Insomnia; Melatonin; Pharmacotherapy; Supplements
Document Type: Research Article
Publication date: 01 May 2011
- The Consultant Pharmacist® is the official peer-reviewed journal of the American Society of Consultant Pharmacists. It is dedicated exclusively to the medication needs of the elderly in all settings, including adult day care, ambulatory care, assisted living, community, hospice, and nursing facilities. This award-winning journal is a member benefit of ASCP. Individuals who are not members and wish to receive The Consultant Pharmacist® will want to consider joining ASCP.
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