Insomnia: Pharmacologic Treatment

Clin Geriatr Med. 2021 Aug;37(3):401-415. doi: 10.1016/j.cger.2021.04.003. Epub 2021 Jun 4.

Abstract

Insomnia afflicts many geriatric patients worldwide and results in both clinical and economic consequences. Prescribing hypnotics to the elderly is particularly challenging due to multitudes of adverse effects and drug interactions. Although benzodiazepines and "Z" drugs such as zolpidem have been popular in the past, they carry a high risk of adverse effects in the elderly, such as devastating falls and injuries as well as potentially an increase in mortality. Newer classes of hypnotics such as dual orexin receptor antagonists are much better tolerated and can be explored as a potential treatment for insomnia in the elderly.

Keywords: Adverse effects; Elderly; Geriatrics; Insomnia; Pharmacology.

Publication types

  • Review

MeSH terms

  • Aged
  • Aging
  • Antidepressive Agents / adverse effects
  • Antidepressive Agents / therapeutic use
  • Benzodiazepines / adverse effects
  • Benzodiazepines / therapeutic use
  • Humans
  • Hypnotics and Sedatives / adverse effects
  • Hypnotics and Sedatives / therapeutic use*
  • Melatonin / adverse effects
  • Melatonin / therapeutic use
  • Orexin Receptor Antagonists / adverse effects
  • Orexin Receptor Antagonists / therapeutic use
  • Sleep / drug effects*
  • Sleep Aids, Pharmaceutical / adverse effects
  • Sleep Aids, Pharmaceutical / therapeutic use*
  • Sleep Initiation and Maintenance Disorders / drug therapy*

Substances

  • Antidepressive Agents
  • Hypnotics and Sedatives
  • Orexin Receptor Antagonists
  • Sleep Aids, Pharmaceutical
  • Benzodiazepines
  • Melatonin