THERAPEUTICS

Brands

• Dalmane
• see index for additional brand names

Generic?

• Yes

Class

• Benzodiazepine (hypnotic)

Commonly Prescribed For

• (bold for FDA approved)
• Insomnia characterized by difficulty in falling asleep, frequent nocturnal awakenings, and/or early morning awakening
• Recurring insomnia or poor sleeping habits
• Acute or chronic medical situations requiring restful sleep

How The Drug Works

• Binds to benzodiazepine receptors at the GABA-A ligand-gated chloride channel complex
• Enhances the inhibitory effects of GABA
• Boosts chloride conductance through GABA-regulated channels
• Inhibitory actions in sleep centers may provide sedative hypnotic effects

How Long Until It Works

• Generally takes effect in less than an hour

If It Works

• Improves quality of sleep
• Effects on total wake-time and number of nighttime awakenings may be decreased over time

If It Doesn’t Work

• If insomnia does not improve after 7–10 days, it may be a manifestation of a primary psychiatric or physical illness such as obstructive sleep apnea or restless leg syndrome, which requires independent evaluation
• Increase the dose
• Improve sleep hygiene
• Switch to another agent

Best Augmenting Combos for Partial Response or Treatment-Resistance

• Generally, best to switch to another agent
• Trazodone
• Agents with antihistamine actions (e.g., diphenhydramine, tricyclic antidepressants)

Tests

• In patients with seizure disorders, concomitant medical illness, and/or those with multiple concomitant long-term medications, periodic liver tests and blood counts may be prudent