Efficacy of Hypnotic Medications and Other Medications Used for Insomnia

Efficacy in the treatment of insomnia has been demonstrated for the BzRA hypnotics. Ramelteon has been shown to be efficacious for insomnia characterized by difficulty with sleep onset. Because of the absence of abuse liability, ramelteon may be a viable alternative for individuals for whom concern for substance misuse is high, although it has not been tested in this population. Inadequate scientific evidence is available to conclude that melatonin, sedating antidepressants, antipsychotics, antihistamines, or other drugs are efficacious or should be recommended to treat insomnia. BzRAs have documented efficacy for acute or chronic insomnia in elderly as well as adult populations. In limited studies their effects in patients who have insomnia with comorbid conditions seem to be similar to those reported in research with primary insomnia. Among the BzRAs, the physician can use the differences in pharmacokinetic characteristics (and formulation) that determine duration of action to tailor treatment to the individual patient. There is accumulating evidence that BzRAs can be used effectively and safely for periods of up to 6 to 12 months, consistent with the experience of many physicians and patients and with the therapeutic requirements of a chronic disorder. © 2006 Elsevier Inc. All rights reserved.