Which medications in the drug class Nonbenzodiazepine Hypnotics are used in the treatment of Sleep-Wake Disorders?

Updated: Aug 21, 2019
  • Author: Roy H Lubit, MD, PhD; Chief Editor: Ana Hategan, MD, FRCPC  more...
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Answer

Nonbenzodiazepine Hypnotics

These agents are used for the treatment of acute and short-term insomnia.

Zolpidem (Ambien, Edluar, Zolpimist, Intermezzo)

Zolpidem binds at a benzodiazepine receptor subtype (omega I). This receptor is found more in the central nervous system (CNS) than in the peripheral nervous system, which helps to account for the drug's hypnotic effect without significant muscle-relaxant properties. Unlike benzodiazepines, zolpidem does not suppress normal sleep architecture.

Zolpidem is rapidly absorbed, with a fast onset of action (20-30 min), and thus is a good drug for sleep induction. It decreases sleep latency and increases sleep duration.

Zaleplon (Sonata)

Zaleplon is not structurally related to benzodiazepines, barbiturates, or other drugs with known hypnotic properties. It interacts with the GABA-benzodiazepine receptor complex, causing sedation. It should be taken immediately before bedtime.

Zaleplon decreases the time to sleep onset. Its shorter onset of action means that peak serum concentrations are achieved within 1 hour of administration. This may account for the lower incidence of daytime grogginess and the reduced withdrawal rebound insomnia.

Eszopiclone (Lunesta)

Eszopiclone is a nonbenzodiazepine hypnotic pyrrolopyrazine derivative of the cyclopyrrolone class. Its precise mechanism of action is unknown, but it is believed to interact with GABA receptors at binding domains close to or allosterically coupled to benzodiazepine receptors. It is indicated for treatment of insomnia by decreasing sleep latency and improving sleep maintenance. It has a short half-life (6 h).

The starting dose is 1 mg immediately before bedtime, with at least 7-8 h remaining before the planned time of awakening. The dose may be increased if clinically warranted to 2-3 mg HS in nonelderly adults, and 2 mg in elderly or debilitated patients.


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