Insomnia

Question 1

What are some anticholinergics used for sleep onset or maintenance? What are some side effects of these meds?

Answer 1

Diphenhydramine, doxepin, hydroxyzine, and doxylamine.
Side effects: exacerbates constipation, BPH, dry eyes, mouth, confusion

Question 2

How is doxepin different from the other anticholinergics that are used for sleep?

Answer 2

Doxepin is used for sleep maintenance.

Question 3

What is the brand name for ramelteon?

Answer 3

Rozerem.
Side effects of dizziness and GI
Lower risk for falls in CNS effects in geriatric patients vs benzo and Z drugs

Question 4

What is the brand name for suvorexant? What is it used for?

Answer 4

Belsomra should be used short term <4-8 weeks
Beneficial for sleep ONSET or MAINTENANCE
*CYP3A4 substrate, 3A4 inhibitors can raise concentrations and increase risk for toxicity
*Inhibitors: non-azith macrolides, itra and ketoconazole, grapefruit, verapamil and diltiazem, ritonavir