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4.7 Sleep disorders

First line drugs Second line drugs Specialist drugs Secondary care drugs

Traffic light status (TLS) explained:

  • Green: Routine prescribing within licensed indication
  • Amber 1: specialist recommendation followed by GP initiation and continuation
  • Amber 2: specialist or GP initiation in line with local guideline after 1st line failure followed by GP continuation
  • Amber 3: specialist initiation and stabilisation followed by GP continuation
  • Amber SCG: specialist initiation and stabilisation followed by GP continuation in line with an agreed shared care guideline
  • Red: Hospital or specialist prescribing only

 

 

4.7.1 Insomnia 

 

Hypnotics should not be used regularly and are only licensed and recommended for short-term use (2-4 weeks). Z–hypnotics should not exceed four weeks use. Ref: CSM Current problems no. 21 Jan 1988, Department of Health CMO update Jan 2004, MeRec Bulletin 15 vol 5.

 

Benzodiazepines

Diazepam

 

Nitrazepam  

  • Tablets 5mg

 

Temazepam CD  

  • Tablets 10mg, 20mg
  • Oral solution, Sugar Free, 10mg in 5mL

Notes:

  • Temazepam has been included as it has a short duration of action and has no active metabolites.

 

  • Temazepam is a Schedule 3 controlled drug; a maximum of 30 days supply for all controlled drugs is the good practice advice from the Department of Health. Ref: Safer Management of Controlled Drugs, May 2007. 

 

 

CNS depressants

Chloral hydrate

  • Liquid 500mg in 5mL  U

Notes:

  • Choral hydrate and its derivatives are considered less suitable for prescribing. There is no convincing evidence that they are particularly useful in the elderly and their role as hypnotics is now very limited.   

 

 

Clomethiazole (Amber 2)

  • Capsule 192mg

 

Melatonin

  • Circadin ® Tablets, Modified release, 2mg

Notes:

 

  • 1. Paediatric use (Amber 1) Melatonin must only be initiated by a paediatrician in children.

 

  • 2. Adult use (Amber 3) Melatonin is approved for use in patients with Parkinsons Disease.The hospital will provide the initial 14 days supply and ensure patient is responding to therapy before continuation of prescribing is transferred to the GP.

 

  • 3.Adult use (Red) Melatonin is approved for new onset delirium whilst an in-patient. It must be initiated by a Consultant Neurologist – Hospital to provide the full course and no further supply should be required from the GP;

 

 

Zolpidem Tartrate

  • Tablets 5mg, 10mg  

 

Zopiclone

  • Tablets 3.75mg, 7.5mg   

Notes:

  • Although zopiclone is not a benzodiazepine it acts on the same receptors as benzodiazepine.

 

  • It is not licensed for long-term use (maximum 4 weeks) and there is evidence of dependence in a small number of patients. It is claimed to not affect sleep architecture.

 

 

 

Antihistamine

Promethazine

    • Tablets 10mg, 25mg
    • Elixir 5mg/5mL
 
Notes:
  • Promethazine may be a useful alternative to benzodiazepines and other hypnotics for night time sedation. However, residual sedation may occur the following day and its sedative effects may diminish after a few days of continued treatment.
  • Prescribers are reminded that promethazine is not licensed for use in children less than two years of age.

 

 

Treatment of Narcolepsy

 

Sodium oxybate [CD]

  • Oral solution, sugar-free, 500mg/ml

Notes:

 

 

 

 

 

Traffic light status (TLS) explained:

  • Green: Routine prescribing within licensed indication
  • Amber 1: specialist recommendation followed by GP initiation and continuation
  • Amber 2: specialist or GP initiation in line with local guideline after 1st line failure followed by GP continuation
  • Amber 3: specialist initiation and stabilisation followed by GP continuation
  • Amber SCG: specialist initiation and stabilisation followed by GP continuation in line with an agreed shared care guideline
  • Red: Hospital or specialist prescribing only

 

Return to Chapter: 4. Nervous System

Last updated by: Sheila Wood on 07-08-2019 10:50