Indications for DORAL:
Use lowest effective dose. ≥18yrs: Initially 7.5mg at bedtime; may increase to 15mg if needed.
<18yrs: not established.
Sleep apnea. Pulmonary insufficiency.
Risks from concomitant use with opioids; see Interactions. Monitor for CNS depressant effects and daytime impairment. Evaluate for co-morbid diagnoses before initiation (eg, psychiatric or physical disorder). Reevaluate if insomnia persists after 7–10 days of use. Depression. Avoid prolonged use. Drug or alcohol abuse. Write ℞ for smallest practical amount. Avoid abrupt cessation. Elderly. Debilitated. Pregnancy (Cat.C). Nursing mothers.
Increased sedation, respiratory depression, coma, and death with concomitant opioids; reserve use in those for whom alternative treatment options are inadequate; if needed, limit dosages/durations to minimum and monitor. Concomitant other sedative/hypnotics: not recommended. Additive CNS depressant effects with alcohol or other CNS depressants (eg, other benzodiazepines, TCAs, psychotropics, anticonvulsants, antihistamines); consider dose reductions.
Drowsiness, headache, fatigue, dizziness, dry mouth, dyspepsia; CNS depression, abnormal thinking/behavior changes, complex sleep-related behaviors (eg, sleep-driving), paradoxical reactions, angioedema, anaphylaxis.