Sleep Disorders: Treatments

SLEEP DISORDERS: TREATMENTS
Generic Brand Strength Form Dose1 Notes
INSOMNIA
doxepin Silenor Rx 3mg, 6mg tabs Adults: Initially 6mg once daily; max: 6mg/day. Elderly, hepatic impairment, tendency to urinary retention: initially 3mg once daily.
Children: Not recommended.
Take within 30mins of bedtime. Do not take within 3hrs of a meal.
eszopiclone Lunesta CIV 1mg, 2mg, 3mg tabs Adults: Initially 1mg; may increase to 2–3mg if needed; max 3mg/dose. Elderly, debilitated, concomitant CYP3A4 inhibitors, or severe hepatic impairment: max 2mg/dose.
Children: <18yrs: Not established.
Effects delayed if taken with or after a heavy/ high-fat meal. Take immediately before bedtime (with ≥7–8hrs remaining before planned time of awakening).
estazolam CIV 1mg+, 2mg+ tabs Adults: Initially 1mg at bedtime; may increase to 2mg nightly. Small or debilitated elderly: initially 0.5mg.
Children: <18yrs: Not recommended.
flurazepam CIV 15mg, 30mg caps Adults: 15–30mg at bedtime. Elderly or debilitated: initially 15mg at bedtime.
Children: <15yrs: Not recommended.
lemborexant Dayvigo CIV 5mg, 10mg tabs Adults: 5mg once per night; may increase to max 10mg/day based on clinical response and tolerability. Concomitant weak CYP3A inhibitors, moderate hepatic impairment: max 5mg/day.
Children: Not established.
Effect may be delayed if taken with or soon after a meal. Take immediately before bedtime, with (≥7hrs) remaining before the planned time of awakening.
quazepam Doral CIV 15mg+ tabs Adults: Initially 7.5mg at bedtime; may increase to 15mg if needed.
Children: Not established.
ramelteon Rozerem Rx 8mg tabs Adults: Take 8mg within 30mins of bedtime.
Children: Not recommended.
Do not take with high-fat/heavy meals (delays effect).
suvorexant Belsomra CIV 5mg, 10mg, 15mg, 20mg tabs Adults: 10mg once per night; may increase if ineffective; max 20mg/day. Concomitant moderate CYP3A inhibitors: 5mg; max 10mg/day.
Children: Not established.
Effect may be delayed if taken with or soon after a meal. Take within 30mins of bedtime if able to get full night’s sleep (≥7hrs) before awakening.
temazepam Restoril CIV 7.5mg, 15mg, 22.5mg, 30mg caps Adults: Usual dose: 7.5mg–30mg at bedtime. Elderly or debilitated: initially 7.5mg.
Children: Not established.
triazolam Halcion CIV 0.25mg+ tabs Adults: 0.125–0.25mg at bedtime; max 0.5mg. Elderly: initially 0.125mg; max 0.25mg.
Children: Not established.
Reevaluate if used ≥3wks.
zaleplon Sonata CIV 5mg, 10mg caps2 Adults: 10mg; max 20mg. Mild to moderate hepatic impairment, concomitant cimetidine, or low weight patients: 5mg. Elderly, debilitated: 5mg; max 10mg.
Children: Not established.
Effects delayed if taken with or after a heavy/ high-fat meal. Take immediately prior to bedtime or after patient has gone to bed and experienced difficulty falling asleep (with ≥7–8hrs of sleep remaining).
zolpidem tartrate CIV 1.75mg, 3.5mg SL tabs Adults: Place 1 tab under the tongue and allow to disintegrate completely before swallowing. Women: 1.75mg. Men: 3.5mg. Concomitant CNS depressants, elderly (≥65yrs), hepatic impairment: 1.75mg.
Children: <18yrs: Not recommended.
Effects delayed if taken with or after a meal. Take only once per night as needed (with ≥4hrs of bedtime remaining before planned time of waking).
Ambien CIV 5mg, 10mg tabs Adults: Women: initially 5mg. Men: initially 5mg or 10mg. Both: if 5mg ineffective, may increase to max 10mg. Elderly, debilitated, or mild to moderate hepatic impairment: 5mg.
Children: <18yrs: Not recommended.
Effects delayed if taken with or after a meal. Take once per night immediately before bedtime (with ≥7–8hrs remaining before planned time of awakening).
Ambien CR CIV 6.25mg, 12.5mg ext-rel tabs Adults: Women: initially 6.25mg. Men: initially 6.25mg or 12.5mg. Both: if 6.25mg ineffective, may increase to max 12.5mg. Elderly, debilitated, or mild to moderate hepatic impairment: 6.25mg.
Children: <18yrs: Not recommended.
Edluar CIV 5mg, 10mg SL tabs Adults: Place 1 tab under the tongue and allow to dissolve; do not take with water. Women: initially 5mg. Men: initially 5mg or 10mg. Both: if 5mg ineffective, may increase to max 10mg. Elderly, debilitated, or hepatic impairment: 5mg.
Children: <18yrs: Not recommended.
Zolpimist CIV 5mg/spray oral soln spray Adults: Women: initially 5mg (1 actuation). Men: initially 5mg or 10mg (2 actuations). Both: if 5mg ineffective, may increase to max 10mg. Elderly, debilitated, or hepatic impairment: 5mg.
Children: <18yrs: Not recommended.
Effects delayed if taken with or after a meal. Take once per night immediately before bedtime (with ≥7–8hrs remaining before planned time of awakening).
NARCOLEPSY
amphetamine sulfate Evekeo CII 5mg, 10mg tabs Adults and Children: <6yrs: Not recommended. Usual range 5–60mg/day.
6–12yrs: initially 5mg daily, may increase by 5mg/day at weekly intervals.
≥12yrs: initially 10mg daily; may increase by 10mg/day at weekly intervals.
Give first dose upon awakening and additional doses at 4–6hr intervals.
armodafinil Nuvigil CIV 50mg, 150mg, 200mg, 250mg tabs Adults: ≥17yrs: 150mg or 250mg once daily in the AM.
Children: <17yrs: Not recommended.
dextro
amphetamine sulfate
CII 5mg+, 10mg+ tabs Adults: 5–60mg daily in divided doses.
Children: <6yrs: Not recommended.
6–12yrs:
initially 5mg daily; may increase by 5mg/day at weekly intervals.
≥12yrs: initially 10mg daily; may increase by 10mg/day at weekly intervals.
Avoid late evening doses. Give first dose upon awakening and 1–2 more doses 4–6hrs apart.
Dexedrine Spansule CII 5mg, 10mg, 15mg sust-rel caps
Zenzedi CII 2.5mg, 5mg, 7.5mg, 10mg, 15mg, 20mg, 30mg tabs
methylphenidate HCl CII 5mg, 10mg+, 20mg+ tabs Adults: 10–60mg daily in 2–3 divided doses preferably 30–45mins before meals. Chew tabs: take with 8oz of water or other fluid.
Children: <6yrs: Not established. ≥6yrs: initially 5mg twice a day before breakfast and lunch. Increase gradually by 5–10mg per week if needed; max 60mg daily.
May use methylphenidate ER tabs (max 60mg/day) in place of IR tabs when the 8-hr dose of methylphenidate ER corresponds to the titrated 8-hr dose of the IR.
2.5mg, 5mg, 10mg chew tabs3
Methylin Oral Solution CII 5mg/5mL, 10mg/5mL oral soln
Ritalin CII 5mg, 10mg+, 20mg+ tabs Adults: Give in 2–3 divided doses preferably 30–45mins before meals. Usual dose: 20–30mg/day; max 60mg/day.
Children: <6yrs: Not established. ≥6yrs: initially 5mg twice daily before breakfast and lunch. May increase by 5–10mg weekly; max 60mg/day.
mixed dextroamphetamine/ amphetamine salts CII 5mg, 7.5mg, 10mg, 12.5mg, 15mg, 20mg, 30mg double-scored tabs Adults and Children: <12yrs: use dextroamphetamine sulfate. ≥12yrs: Usual range 5–60mg/day in divided doses. Avoid late evening doses; give upon awakening and 4–6hrs apart.
modafinil Provigil CIV 100mg, 200mg+ tabs Adults: ≥17yrs: 200mg once daily in the AM; max 400mg/day. Severe hepatic impairment: 100mg once daily.
Children: <17yrs: Not established.
pitolisant Wakix Rx 4.45mg, 17.8mg tabs Adults: Week 1: initially 8.9mg once daily; Week 2: increase to 17.8mg once daily; Week 3: may increase to max 35.6mg once daily. Adjust dose based on tolerability. Moderate hepatic impairment: initially 8.9mg once daily, may increase to max 17.8mg once daily after 14 days. Moderate to severe renal impairment: initially 8.9mg once daily, may increase to max 17.8mg once daily after 7 days. ESRD: not recommended.
Children: Not established.
Take in the AM upon awakening.
sodium oxybate Xyrem CIII 500mg/mL oral soln Adults: Initially 4.5g/night in 2 equally divided doses, at bedtime then again 2.5–4hrs later. May increase by 1.5g/night (0.75g/dose) at weekly intervals; usual range: 6–9g/night; max 9g/night.
Children: <7yrs: Not established. ≥7yrs (<20kg): see full labeling. ≥7yrs (20–<30kg): initially ≤2g/night in 2 equally divided doses, at bedtime then again 2.5–4hrs later. May increase by 1g/night (0.5g/dose) at weekly intervals. Max total dose: 6g/night.
(30–<45kg): initially ≤3g/night in 2 equally divided doses, at bedtime then again 2.5–4hrs later. May increase by 1g/night (0.5g/dose) at weekly intervals. Max total dose: 7.5g/night.
(≥45kg): initially ≤4.5g/night in 2 equally divided doses, at bedtime then again 2.5–4hrs later. May increase by 1.5g/night (0.75g/dose) at weekly intervals; max total dose: 9g/night.
Take on empty stomach. Dilute each dose with 60mL of water. Some patients may respond better with unequal doses. Allow 6hrs before becoming active after last dose. Consider concomitant CNS stimulant use (see full labeling).
sodium oxybate/ calcium oxybate/ magnesium oxybate/ potassium oxybate Xywav CIII 40mg/ 234mg/ 96mg/ 130mg per mL oral soln Adults: Initially 4.5g/night in 2 equally divided doses, at bedtime then again 2.5–4hrs later. May increase by 1.5g/night (0.75g/dose) at weekly intervals; usual range: 6–9g/night; max 9g/night.
Children: <7yrs: Not established. ≥7yrs (<20kg): see full labeling. ≥7yrs (20–<30kg): initially ≤2g/night in 2 equally divided doses, at bedtime then again 2.5–4hrs later. May increase by 1g/night (0.5g/dose) at weekly intervals. Max total dose: 6g/night.
(30–<45kg): initially ≤3g/night in 2 equally divided doses, at bedtime then again 2.5–4hrs later. May increase by 1g/night (0.5g/dose) at weekly intervals. Max total dose: 7.5g/night.
(≥45kg): initially ≤4.5g/night in 2 equally divided doses, at bedtime then again 2.5–4hrs later. May increase by 1.5g/night (0.75g/dose) at weekly intervals; max total dose: 9g/night.
Take on empty stomach. Dilute each dose with 60mL of water. Some patients may respond better with unequal doses. Allow 6hrs before becoming active after last dose. Consider concomitant CNS stimulant use (see full labeling).
solriamfetol Sunosi CIV 75mg+, 150mg tabs Adults: Initially 75mg once daily; usual range 75–150mg/day. May double dose at intervals of ≥3 days; max 150mg/day. Renal impairment: CrCl 30–59mL/min: initially 37.5mg/day; may increase to max 75mg/day after ≥7 days. CrCl 15–29mL/min: initially and at max 37.5mg/day. CrCl <15mL/min: not recommended.
Children: Not established.
Take upon awakening; avoid within 9hrs of planned bedtime.
NON-24-HOUR
tasimelteon Hetlioz Rx 20mg caps Adults: 20mg once daily before bedtime.
Children: Not established.
Take at the same time every night. Avoid with food.
RESTLESS LEG SYNDROME
gabapentin enacarbil Horizant Rx 300mg, 600mg ext-rel tabs Adults: 600mg once daily at about 5pm with food. No additional benefit with 1200mg. Renal impairment: CrCl 30–59mL/min: initially 300mg/day and increase to 600mg as needed. CrCl 15–29mL/min: 300mg/day. CrCl <15mL/min: 300mg every other day. CrCl <15mL/min on HD: not recommended.
Children: Not studied.
If dose not taken at recommended time, next dose should be taken the following day.
pramipexole Mirapex Rx 0.125mg, 0.25mg+, 0.5mg+, 0.75mg, 1mg+, 1.5mg+ tabs Adults: Initially 0.125mg once daily 2–3 hrs before bedtime. May double dose every 4–7 days; max 0.5mg/day (doses of 0.75mg/day have been used). Renal impairment: increase titration interval to every 14 days if needed.
Children: Not established.
ropinirole Requip Rx 0.25mg, 0.5mg, 1mg, 2mg, 3mg, 4mg, 5mg tabs Adults: Initially 0.25mg on Days 1 & 2, then 0.5mg on Days 3–7, increase by 0.5mg/day at 1-wk intervals to 3mg then may increase to 4mg after 1wk; max 4mg/day. ESRD on HD: initially 0.25mg/day; max 3mg/day.
Children: Not established.
Take once-daily 1–3 hrs before bedtime. Titrate gradually.
NOTES

Key: + = scored; ER = extended-release; HD = hemodialysis; IR = intermediate-release; SL = sublingual

1 Use lowest effective dose

2 Contains tartrazine

3 Contains phenylalanine

Not an inclusive list of medications, official indications, or dosing information. Please see drug monograph at www.eMPR.com and/or contact company for full drug labeling.

(Rev. 2/2021)