Pharmacotherapy Treatment Options for Insomnia: A Primer for Clinicians.
Pharmacotherapy Treatment Options for Insomnia: A Primer for Clinicians.
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DOI：
10.3390/ijms17010050
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发表时间：
2015-12-30
影响因子：
5.6
通讯作者：
Henderson MA
中科院分区：
文献类型：
--
作者：
Asnis GM;Thomas M;Henderson MA
抑郁症是一种普遍存在的疾病，具有有害影响，如生活质量下降，以及易患许多精神疾病。幸运的是，有许多被批准的催眠治疗方法可用。本报告回顾了药物治疗的最新进展，并参考了失眠症的认知行为治疗（CBT-I）。它为临床医生提供了美国食品药品监督管理局（FDA）批准的所有催眠药（苯二氮卓类、非苯二氮卓类、雷美替酮、低剂量辛喹和苏沃雷生）的指南，包括潜在的副作用。慢性失眠通常持续超过2年。认识到这一点，并作为长期研究的结果，FDA自2005年以来批准了所有催眠药，而不限制使用时间。我们的手稿还审查了标签外的催眠药（镇静抗抑郁药，非典型抗精神病药，抗惊厥药和抗组胺药），实际上，这些药物比批准的催眠药更经常处方。选择哪种催眠药的选择进行了讨论，部分是根据睡眠的哪一段被干扰，是否存在共病。最后，我们讨论了FDA最近要求的标签变更，插入了关于“睡眠相关复杂行为”的警告，例如，所有催眠药的睡眠驾驶此外，我们还讨论了FDA规定的大多数唑吡坦制剂在女性中的剂量降低，因为早晨唑吡坦水平较高，可能导致日间残留效应。
Insomnia is a prevalent disorder with deleterious effects such as decreased quality of life, and a predisposition to a number of psychiatric disorders. Fortunately, numerous approved hypnotic treatments are available. This report reviews the state of the art of pharmacotherapy with a reference to cognitive behavioral therapy for insomnia (CBT-I) as well. It provides the clinician with a guide to all the Food and Drug Administration (FDA) approved hypnotics (benzodiazepines, nonbenzodiazepines, ramelteon, low dose sinequan, and suvorexant) including potential side effects. Frequently, chronic insomnia lasts longer than 2 years. Cognizant of this and as a result of longer-term studies, the FDA has approved all hypnotics since 2005 without restricting the duration of use. Our manuscript also reviews off-label hypnotics (sedating antidepressants, atypical antipsychotics, anticonvulsants and antihistamines) which in reality, are more often prescribed than approved hypnotics. The choice of which hypnotic to choose is discussed partially being based on which segment of sleep is disturbed and whether co-morbid illnesses exist. Lastly, we discuss recent label changes required by the FDA inserting a warning about “sleep-related complex behaviors”, e.g., sleep-driving for all hypnotics. In addition, we discuss FDA mandated dose reductions for most zolpidem preparations in women due to high zolpidem levels in the morning hours potentially causing daytime carry-over effects.