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Table 82-1 Medications Other than Benzodiazepine Receptor Agonists Used in the Treatment of Insomnia
EFFICACY IN
PLACEBO-
CONTROLLED
INSOMNIA
TRIALS
FDA
INDICATION
INSOMNIA
DOSAGE (MG)
T MAX
(HR)
T 1/2
(HR) *
MOST COMMON
SIDE-EFFECTS
RELATIVE
CONTRAINDICATIONS
MOST PROMISING
CLINICAL USE
MEDICATION
Sedating Antidepressants
Amitriptyline
MDD
10-100
2-5
10-100 —
Sedation, dizziness,
weight gain, OH, dry
mouth, blurred vision,
constipation, urinary
retention
History of MI, ischemia,
or conduction
abnormalities;
closed-angle
glaucoma; decreased
GI motility; urinary
retention;
hypotension; history
suggestive of bipolar
disorder; Parkinson's
disease; seizure
disorder; liver disease
Insomnia comorbid
with MDD, chronic
pain, or anxiety
Doxepin
MDD, anxiety
1-25
1.5-4
10-50
5/5
Sedation, dizziness;
weight gain, OH, dry
mouth, blurred vision,
constipation, urinary
retention
History of MI, ischemia,
or conduction
abnormalities;
closed-angle
glaucoma; decreased
GI motility; urinary
retention;
hypotension; history
suggestive of bipolar
disorder; Parkinson's
disease; seizure
disorder; liver disease
Eicacy with relative
absence of side
efects at 1-6 mg
Insomnia comorbid
with MDD, chronic
pain, or anxiety
Treatment of early
morning
awakenings
Trimipramine
MDD
25-100
2-8
15-40
2/2
Sedation, dizziness;
weight gain, OH, dry
mouth, blurred vision,
constipation, urinary
retention
History of MI, ischemia,
or conduction
abnormalities
Closed-angle
glaucoma, decreased
GI motility, urinary
retention,
hypotension
History suggestive of
bipolar disorder,
Parkinson's disease,
seizure disorder, liver
disease
Insomnia comorbid
with MDD, chronic
pain, or anxiety
Trazodone
MDD
25-150
1-2
7-15
0/1
Sedation, dizziness,
headache, dry mouth,
blurred vision, OH,
priapism
Liver disease, kidney
disease, suspected
bipolar disorder
Insomnia comorbid
with MDD; insomnia
comorbid with
substance abuse
Mirtazapiine
MDD
7.5-30
0.25-2
20-40 —
Sedation, dry mouth,
increased appetite;
weight gain;
constipation
Patients with suspected
bipolar disorder; liver
disease; kidney
disease
Insomnia comorbid
with MDD; Insomnia
comorbid with SBD
Continued
 
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