Other drugs | Mechanism of action | Clinical use* | Adult dose (usual) | Dose in older adults (≥65 years) | Half-life (hours) | Potential for drug interactions¶ |
Doxepin | Histamine H1 receptor antagonismΔ | Sleep maintenance insomnia | 3 to 10 mg◊ | 3 to 6 mg | Long (15 drug; 31 active metabolite) | Moderate Doxepin clearance is largely dependent on CYP2D6 Avoid use within two weeks of MAOI administration |
Ramelteon | Melatonin receptor agonist | Sleep onset insomnia | 8 mg | 8 mg | Short (1 to 2.6 drug; 2 to 5 active metabolite) | Moderate Ramelteon clearance is largely dependent on CYP1A2 and CYP2C9 |
Lemborexant | Orexin receptor antagonist | Sleep onset or sleep maintenance insomnia | 5 to 10 mg | 5 mg | Long (17 to 19) | Significant drug interactions Lemborexant clearance is dependent on CYP3A4 If used in combination with mild inhibitors of CYP3A4, recommended dose is 5 mg Avoid use of lemborexant with moderate and strong inhibitors and inducers of CYP3A4 |
Suvorexant | Orexin receptor antagonist | Sleep onset or sleep maintenance insomnia | 10 to 20 mg | 10 to 15 mg | Intermediate (12) | Significant drug interactions Suvorexant clearance is largely dependent on CYP3A If used in combination with moderate inhibitors of CYP3A, recommended dose is 5 mg; may increase to 10 mg Avoid use of suvorexant with strong inhibitors or inducers of CYP3A |
Daridorexant | Orexin receptor antagonist | Sleep onset or sleep maintenance insomnia | 25 to 50 mg | 25 to 50 mg | Intermediate (8) | Significant drug interactions Daridorexant clearance is largely dependent on CYP3A If used in combination with moderate inhibitors of CYP3A, recommended dose is 25 mg Avoid use of daridorexant with strong inhibitors or moderate/strong inducers of CYP3A |
Trazodone§ | Serotonin 5-HT2A, alpha-1 adrenergic, and histamine H1 receptor antagonismΔ | Sleep onset or sleep maintenance insomnia | 50 to 100 mg | 25 to 100 mg | Intermediate (5 to 9) | Moderate Trazodone is metabolized by CYP3A4 to an active metabolite; use with caution in combination with other serotonergic drugs |