Treatment regimen and hypnotic self-administration

Roehrs, Timothy; Bonahoom, Alicia; Pedrosi, Bonita; Rosenthal, León; Roth, Thomas

doi:10.1007/s002130000661

Cited by 19 publications

(12 citation statements)

References 7 publications

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“…Non-nightly treatment regimens have been suggested due to concerns in regard to tolerance development and the development of physical/ behavioral dependence. As previously noted, tolerance does not readily develop, physical dependence is not observed, and a non-nightly treatment regimen did not alter the likelihood of behavioral dependence in a short-term study [95]. There is no clear advantage to non-nightly treatment regimens, at least in regard to the risks of tolerance or abuse.…”

Section: Specific Nature Of Insomnia and Patient Characteristicsmentioning

confidence: 61%

Insomnia Pharmacotherapy

2012

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Summary The benzodiazepine receptor agonists (BzRAs) a melatonin receptor agonist and a histamine antagonist have all been approved as hypnotics. Beyond their differing mechanisms of action, they have differences in pharmacokinetics, and among the BzRAs differences in receptor subtype affinity and formulations, which provides the physician with broad options for tailoring therapy to each patient's specific needs. Consistent with their specific pharmacokinetics and formulations, these Food and Drug Administration-approved hypnotics have been shown to improve sleep with no evidence of tolerance development in long-term use. In addition, emerging data indicate these drugs also improve aspects of daytime function. Their side effects are either associated with the direct sedating effects of the drugs, doses greater than clinical doses, or a combination with alcohol or other sedating drugs. Anxiolytic BzRAs, sedating antidepressants and antipsychotics have been used off-label as hypnotics. However, in the absence of information regarding their dose range for efficacy and safety, their use as hypnotics is ill-advised.

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Section: Specific Nature Of Insomnia and Patient Characteristicsmentioning

confidence: 61%

Insomnia Pharmacotherapy

2012

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“…In the only study with adequate data for meta-analysis, Roehrs 96 found a small reduction in subjective SL (−9.2 min; CI: −22.3 to +3.9 min) which fell below clinical significance. Quality of evidence for these data was high.…”

Section: Sleep Latencymentioning

confidence: 88%

“…Because only one study 96 contained data of sufficient quality, meta-analysis was not performed. The quality of evidence for this study was high.…”

Section: Discussionmentioning

confidence: 99%

0395 Clinical Practice Guideline for the Pharmacologic Treatment of Chronic Insomnia in Adults: An American Academy of Sleep Medicine Clinical Practice Guideline

Sateia

Buysse

Krystal

et al. 2017

Sleep

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Introduction:The purpose of this guideline is to establish clinical practice recommendations for the pharmacologic treatment of chronic insomnia in adults, when such treatment is clinically indicated. Unlike previous meta-analyses, which focused on broad classes of drugs, this guideline focuses on individual drugs commonly used to treat insomnia. It includes drugs that are FDA-approved for the treatment of insomnia, as well as several drugs commonly used to treat insomnia without an FDA indication for this condition. This guideline should be used in conjunction with other AASM guidelines on the evaluation and treatment of chronic insomnia in adults. Methods: The American Academy of Sleep Medicine commissioned a task force of four experts in sleep medicine. A systematic review was conducted to identify randomized controlled trials, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) process was used to assess the evidence. The task force developed recommendations and assigned strengths based on the quality of evidence, the balance of benefits and harms, and patient values and preferences. Literature reviews are provided for those pharmacologic agents for which sufficient evidence was available to establish recommendations. The AASM Board of Directors approved the final recommendations. Recommendations:The following recommendations are intended as a guideline for clinicians in choosing a specific pharmacological agent for treatment of chronic insomnia in adults, when such treatment is indicated. Under GRADE, a STRONG recommendation is one that clinicians should, under most circumstances, follow. A WEAK recommendation reflects a lower degree of certainty in the outcome and appropriateness of the patient-care strategy for all patients, but should not be construed as an indication of ineffectiveness. GRADE recommendation strengths do not refer to the magnitude of treatment effects in a particular patient, but rather, to the strength of evidence in published data. Downgrading the quality of evidence for these treatments is predictable in GRADE, due to the funding source for most pharmacological clinical trials and the attendant risk of publication bias; the relatively small number of eligible trials for each individual agent; and the observed heterogeneity in the data. The ultimate judgment regarding propriety of any specific care must be made by the clinician in light of the individual circumstances presented by the patient, available diagnostic tools, accessible treatment options, and resources.1. We suggest that clinicians use suvorexant as a treatment for sleep maintenance insomnia (versus no treatment) in adults. (WEAK) 2. We suggest that clinicians use eszopiclone as a treatment for sleep onset and sleep maintenance insomnia (versus no treatment) in adults. (WEAK) 3. We suggest that clinicians use zaleplon as a treatment for sleep onset insomnia (versus no treatment) in adults. (WEAK) 4. We suggest that clinicians use zolpidem as a treatment for sleep onset and sleep maintenance in...

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“…There is a strong placebo effect in insomnia patients and they self-administer capsules, whether placebo or active drug, on 60% to 80% of nightly opportunities. Another recent short-term study sought to determine whether an 11-night intermittent treatment instruction compared with a nightly bedtime and an as required instruction would alter the subsequent likelihood of self-administering a hypnotic (triazolam, 0.25 mg) over a 1-week free-choice period [10]. Experience with the prior intermittent treatment (ie, capsules every third night) did not alter subsequent drug taking compared with prior nightly dosing at bedtime or the as necessary at bedtime instruction.…”

Section: Chronic Use In Chronic Insomniamentioning

confidence: 99%

Hypnotics: An update

Roehrs

Roth

2003

Curr Neurol Neurosci Rep

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This update reviews recent developments and advances in the therapeutic and side-effect profile of the benzodiazepine receptor agonists (BZRAs), the generally accepted drug class of choice for the symptomatic treatment of insomnia. All the approved BZRAs, depending on their pharmacokinetic profile, improve and maintain sleep. The major recent advance is in the enhanced diversity of the pharmacokinetic profiles of these drugs, and thus in the flexibility available to the clinician in treatment strategy. Also, during the past decade the nature and significance of the side effects associated with the BZRAs and their determinants, dose and half-life, have been identified and clarified. The important remaining question is whether, and how, the efficacy and safety of the BZRAs change with chronic use.

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Treatment regimen and hypnotic self-administration

Abstract: The data of this study are consistent with the view that hypnotic self-administration by insomniacs is therapy-seeking behavior and not drug abuse.

Cited by 19 publications

References 7 publications

Insomnia Pharmacotherapy

Insomnia Pharmacotherapy

0395 Clinical Practice Guideline for the Pharmacologic Treatment of Chronic Insomnia in Adults: An American Academy of Sleep Medicine Clinical Practice Guideline

Hypnotics: An update

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