4.1.1 Hypnotics

Drugs used for insomnia not listed below:

Patient information leaflet - NEW Devon CCG Good Sleep Guide

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.

CNS depressants

Zopiclone
  • Tablets 3.75mg, 7.5mg (£1.11 = 7.5mg)

Indications

  • Insomnia including nocturnal and early awakening (short-term use, up to 4 weeks)

Dose

  • Adult over 18 years, 7.5mg at bedtime; elderly initially 3.75mg at bedtime increased if necessary

Notes

  1. NICE TA77: Zaleplon, zolpidem and zopiclone for the short-term management of insomnia (April 2004). The recommendations originally included zaleplon, but this drug no longer has a marketing authorisation in the UK.
Zolpidem
  • Tablets 5mg, 10mg (£1.11 = 10mg)

Indications

  • Insomnia (short-term use, up to 4 weeks)

Dose

  • Adult over 18 years, 10mg at bedtime; elderly or debilitated 5mg at bedtime

Notes

  1. Contraindicated in obstructive sleep apnoea
  2. NICE TA77: Zaleplon, zolpidem and zopiclone for the short-term management of insomnia (April 2004). The recommendations originally included zaleplon, but this drug no longer has a marketing authorisation in the UK.
Melatonin
  • Circadin® tablets m/r 2mg (£15.39 = 30 tablets)

Indications and dose

  • Child 1 month–18 years: initially 2mg daily before bedtime increased if necessary after 1–2 weeks to 4–6mg daily before bedtime; maximum 10mg daily (unlicensed in this age group)

Notes

  1. Melatonin tablets may be prescribed in primary care on the advice of a specialist for use only to aid sleep cycle synchronisation in children with sensory impairment, autistic spectrum disorder, in other neurodisability / neuropsychiatric / neurodevelopmental disorders including ADHD when behavioural measures have been insufficient.
  2. Where a patient cannot swallow Circadin® tablets they may be crushed, which then gives an immediate release product which may be beneficial in some patients. The use of Circadin® in this way will be outside of the product license however this is preferable to using an unlicensed product.
  3. Therapy should be reviewed at least every 6 months (BNF). Periodic review by the specialist paediatrician is recommended at appropriate intervals
  4. Other melatonin products are available and in use often for historical reasons. It is considered appropriate for GPs to initiate discussions with patients and carers about changing to the Circadin® formulation. The discussion should include a consideration about the practicalities of taking/administering the dose. There is no need to refer to a paediatrician simply to ask for a review of formulation but support is available if required.

Narcolepsy

Drugs used for narcolepsy not listed below:

Sodium oxybate
  • Oral solution 500mg in 1ml (£360.00 = 180ml)

Indications

  • Narcolepsy with cataplexy

Notes

  1. Only to be used in primary care in line with the NEW Devon CCG Specialised Medicines Service prescribing guidelines
  2. To avoid unnecessary out of pocket expenses, practices or pharmacies should order Xyrem® direct from Alloga UK via allogauk.orders@alloga.co.uk or 01773 441702 (please state which wholesaler you wish to be invoiced through)
  3. The routine commissioning of sodium oxybate has been accepted in Devon for the management of narcolepsy with cataplexy in adults aged 19 years and older only in line with specific criteria (see Commissioning Policy for more details)

 

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