Guidelines for the Use of Hypnotics
Define a clear indication and treatment goal. |
Prescribe the lowest effective dose. |
Except for specific hypnotics and patients, limit duration of use to a few weeks. |
Individualize the dose for each patient. |
Use lower doses in patients also taking a central nervous system depressant, in older people, and in patients with hepatic or renal disorders. |
Avoid* if patients have sleep apnea or respiratory disorders or a history of sedative abuse, if they drink alcohol, or if they are pregnant. |
For patients who need longer-term treatment, consider intermittent therapy. |
Avoid abruptly stopping the hypnotic if possible (ie, taper it). |
Reevaluate hypnotic treatment regularly; assess efficacy and adverse events. |
* Ramelteon is an exception; it can be given to patients with mild to moderate obstructive sleep apnea or chronic obstructive pulmonary disease (COPD) or a history of sedative abuse. Low-dose doxepin also has no abuse liability.* Ramelteon is an exception; it can be given to patients with mild to moderate obstructive sleep apnea or chronic obstructive pulmonary disease (COPD) or a history of sedative abuse. Low-dose doxepin also has no abuse liability. |