Sleep Disorders: Treatments

SLEEP DISORDERS: TREATMENTS
Generic	Brand		Strength	Form	Dose¹	Notes
INSOMNIA
daridorexant	Quviviq	CIV	25mg, 50mg	tabs	Adults: 25–50mg once per night. Concomitant moderate CYP3A4 inhibitors or moderate hepatic impairment: max 25mg once per night. Children: Not established.	Take within 30mins of bedtime (with ≥7hrs remaining prior to planned awakening). Effect may be delayed if taken with or soon after a meal.
doxepin	Silenor	Rx	3mg, 6mg	tabs	Adults: Initially 6mg once daily; max: 6mg/day. Elderly, hepatic impairment, tendency to urinary retention: initially 3mg once daily. Children: Not recommended.	Take within 30mins of bedtime. Do not take within 3hrs of a meal.
eszopiclone	Lunesta	CIV	1mg, 2mg, 3mg	tabs	Adults: Initially 1mg; may increase to 2–3mg if needed; max 3mg/dose. Elderly, debilitated, concomitant CYP3A4 inhibitors, or severe hepatic impairment: max 2mg/dose. Children: <18yrs: Not established.	Effects delayed if taken with or after a heavy/ high-fat meal. Take immediately before bedtime (with ≥7–8hrs remaining before planned time of awakening).
estazolam	—	CIV	1mg+, 2mg+	tabs	Adults: Initially 1mg at bedtime; may increase to 2mg nightly. Small or debilitated elderly: initially 0.5mg. Children: <18yrs: Not recommended.
flurazepam	—	CIV	15mg, 30mg	caps	Adults: 15–30mg at bedtime. Elderly or debilitated: initially 15mg at bedtime. Children: <15yrs: Not recommended.
lemborexant	Dayvigo	CIV	5mg, 10mg	tabs	Adults: 5mg once per night; may increase to max 10mg/day based on clinical response and tolerability. Concomitant weak CYP3A inhibitors, moderate hepatic impairment: max 5mg/day. Children: Not established.	Effect may be delayed if taken with or soon after a meal. Take immediately before bedtime, with (≥7hrs) remaining before the planned time of awakening.
quazepam	Doral	CIV	15mg+	tabs	Adults: Initially 7.5mg at bedtime; may increase to 15mg if needed. Children: Not established.
ramelteon	Rozerem	Rx	8mg	tabs	Adults: Take 8mg within 30mins of bedtime. Children: Not recommended.	Do not take with high-fat/heavy meals (delays effect).
suvorexant	Belsomra	CIV	5mg, 10mg, 15mg, 20mg	tabs	Adults: 10mg once per night; may increase if ineffective; max 20mg/day. Concomitant moderate CYP3A inhibitors: 5mg; max 10mg/day. Children: Not established.	Effect may be delayed if taken with or soon after a meal. Take within 30mins of bedtime if able to get full night’s sleep (≥7hrs) before awakening.
temazepam	Restoril	CIV	7.5mg, 15mg, 22.5mg, 30mg	caps	Adults: Usual dose: 7.5mg–30mg at bedtime. Elderly or debilitated: initially 7.5mg. Children: Not established.
triazolam	Halcion	CIV	0.25mg+	tabs	Adults: 0.125–0.25mg at bedtime; max 0.5mg. Elderly: initially 0.125mg; max 0.25mg. Children: Not established.	Reevaluate if used ≥3wks.
zaleplon	Sonata	CIV	5mg, 10mg	caps²	Adults: 10mg; max 20mg. Mild to moderate hepatic impairment, concomitant cimetidine, or low weight patients: 5mg. Elderly, debilitated: 5mg; max 10mg. Children: Not established.	Effects delayed if taken with or after a heavy/ high-fat meal. Take immediately prior to bedtime or after patient has gone to bed and experienced difficulty falling asleep (with ≥7–8hrs of sleep remaining).
zolpidem tartrate	—	CIV	1.75mg, 3.5mg	SL tabs	Adults: Place 1 tab under the tongue and allow to disintegrate completely before swallowing. Women: 1.75mg. Men: 3.5mg. Concomitant CNS depressants, elderly (≥65yrs), hepatic impairment: 1.75mg. Children: <18yrs: Not recommended.	Effects delayed if taken with or after a meal. Take only once per night as needed (with ≥4hrs of bedtime remaining before planned time of waking).
	Ambien	CIV	5mg, 10mg	tabs	Adults: Women: initially 5mg. Men: initially 5mg or 10mg. Both: if 5mg ineffective, may increase to max 10mg. Elderly, debilitated, or mild to moderate hepatic impairment: 5mg. Children: <18yrs: Not recommended.	Effects delayed if taken with or after a meal. Take once per night immediately before bedtime (with ≥7–8hrs remaining before planned time of awakening).
	Ambien CR	CIV	6.25mg, 12.5mg	ext-rel tabs	Adults: Women: initially 6.25mg. Men: initially 6.25mg or 12.5mg. Both: if 6.25mg ineffective, may increase to max 12.5mg. Elderly, debilitated, or mild to moderate hepatic impairment: 6.25mg. Children: <18yrs: Not recommended.
	Edluar	CIV	5mg, 10mg	SL tabs	Adults: Place 1 tab under the tongue and allow to dissolve; do not take with water. Women: initially 5mg. Men: initially 5mg or 10mg. Both: if 5mg ineffective, may increase to max 10mg. Elderly, debilitated, or hepatic impairment: 5mg. Children: <18yrs: Not recommended.
IDIOPATHIC HYPERSOMNIA
sodium oxybate/ calcium oxybate/ magnesium oxybate/ potassium oxybate	Xywav	CIII	40mg/234mg/ 96mg/130mg per mL	oral soln	Adults: Twice nightly regimen: initially ≤4.5g/night in 2 equally divided doses, at bedtime then again 2.5–4hrs later. May increase by ≤1.5g/night (0.75g/dose) at weekly intervals; max 9g/night. Once nightly regimen: initially ≤3g/night. May increase by 1.5g/night at weekly intervals; max 6g/night. Children: Not established.	Take on empty stomach. Dilute each dose with 60mL of water. May change between twice and once nightly regimens during titration based on efficacy and tolerability.
NARCOLEPSY
amphetamine sulfate	Evekeo	CII	5mg, 10mg	tabs	Adults and Children: <6yrs: Not recommended. Usual range 5–60mg/day. 6–12yrs: initially 5mg daily, may increase by 5mg/day at weekly intervals. ≥12yrs: initially 10mg daily; may increase by 10mg/day at weekly intervals.	Give first dose upon awakening and additional doses at 4–6hr intervals.
armodafinil	Nuvigil	CIV	50mg, 150mg, 200mg, 250mg	tabs	Adults: ≥17yrs: 150mg or 250mg once daily in the AM. Children: <17yrs: Not recommended.
dextro– amphetamine sulfate	—	CII	5mg+, 10mg+	tabs	Adults: 5–60mg daily in divided doses. Children: <6yrs: Not recommended. 6–12yrs: initially 5mg daily; may increase by 5mg/day at weekly intervals. ≥12yrs: initially 10mg daily; may increase by 10mg/day at weekly intervals.	Avoid late evening doses. Give first dose upon awakening and 1–2 more doses 4–6hrs apart.
	Dexedrine Spansule	CII	5mg, 10mg, 15mg	sust-rel caps
	Zenzedi	CII	2.5mg, 5mg, 7.5mg, 10mg, 15mg, 20mg, 30mg	tabs
methylphenidate HCl	—	CII	5mg, 10mg+, 20mg+	tabs	Adults: 10–60mg daily in 2–3 divided doses preferably 30–45mins before meals. Chew tabs: take with 8oz of water or other fluid. Children: <6yrs: Not established. ≥6yrs: initially 5mg twice a day before breakfast and lunch. Increase gradually by 5–10mg per week if needed; max 60mg daily.	May use methylphenidate ER tabs (max 60mg/day) in place of IR tabs when the 8-hr dose of methylphenidate ER corresponds to the titrated 8-hr dose of the IR.
	—	CII	2.5mg, 5mg, 10mg	chew tabs³
	Methylin Oral Solution	CII	5mg/5mL, 10mg/5mL	oral soln
	Ritalin	CII	5mg, 10mg+, 20mg+	tabs	Adults: Give in 2–3 divided doses preferably 30–45mins before meals. Usual dose: 20–30mg/day; max 60mg/day. Children: <6yrs: Not established. ≥6yrs: initially 5mg twice daily before breakfast and lunch. May increase by 5–10mg weekly; max 60mg/day.
mixed dextro–amphetamine/ amphetamine salts	—	CII	5mg, 7.5mg, 10mg, 12.5mg, 15mg, 20mg, 30mg	double-scored tabs	Adults and Children: <12yrs: use dextroamphetamine sulfate. ≥12yrs: Usual range 5–60mg/day in divided doses.	Avoid late evening doses; give upon awakening and 4–6hrs apart.
modafinil	Provigil	CIV	100mg, 200mg+	tabs	Adults: ≥17yrs: 200mg once daily in the AM; max 400mg/day. Severe hepatic impairment: 100mg once daily. Children: <17yrs: Not established.
pitolisant	Wakix	Rx	4.45mg, 17.8mg	tabs	Adults: Week 1: initially 8.9mg once daily; Week 2: increase to 17.8mg once daily; Week 3: may increase to max 35.6mg once daily. Adjust dose based on tolerability. Moderate hepatic impairment: initially 8.9mg once daily, may increase to max 17.8mg once daily after 14 days. Moderate to severe renal impairment: initially 8.9mg once daily, may increase to max 17.8mg once daily after 7 days. ESRD: not recommended. Children: Not established.	Take in the AM upon awakening.
sodium oxybate	Lumryz	CIII	4.5g, 6g, 7.5g, 9g	pkts for ext-rel oral susp	Adults: Initially 4.5g/night as a single dose. May increase by 1.5g/night at weekly intervals; usual range: 6–9g/night; max 9g/night. Switch from immediate-release sodium oxybate: use nearest equivalent dose in g/night. Children: Not established.	Take ≥2hrs after eating. Mix each dose with ~80mL of water. Allow 6hrs before becoming active after last dose.
sodium oxybate	Xyrem	CIII	500mg/mL	oral soln	Adults: Initially 4.5g/night in 2 equally divided doses, at bedtime then again 2.5–4hrs later. May increase by 1.5g/night (0.75g/dose) at weekly intervals; usual range: 6–9g/night; max 9g/night. Children: <7yrs: Not established. ≥7yrs (<20kg): see full labeling. ≥7yrs (20–<30kg): initially ≤2g/night in 2 equally divided doses, at bedtime then again 2.5–4hrs later. May increase by 1g/night (0.5g/dose) at weekly intervals. Max total dose: 6g/night. (30–<45kg): initially ≤3g/night in 2 equally divided doses, at bedtime then again 2.5–4hrs later. May increase by 1g/night (0.5g/dose) at weekly intervals. Max total dose: 7.5g/night. (≥45kg): initially ≤4.5g/night in 2 equally divided doses, at bedtime then again 2.5–4hrs later. May increase by 1.5g/night (0.75g/dose) at weekly intervals; max total dose: 9g/night.	Take on empty stomach. Dilute each dose with 60mL of water. Some patients may respond better with unequal doses. Allow 6hrs before becoming active after last dose. Consider concomitant CNS stimulant use (see full labeling).
sodium oxybate/ calcium oxybate/ magnesium oxybate/ potassium oxybate	Xywav	CIII	40mg/ 234mg/ 96mg/ 130mg per mL	oral soln	Adults: Initially 4.5g/night in 2 equally divided doses, at bedtime then again 2.5–4hrs later. May increase by 1.5g/night (0.75g/dose) at weekly intervals; usual range: 6–9g/night; max 9g/night. Children: <7yrs: Not established. ≥7yrs (<20kg): see full labeling. ≥7yrs (20–<30kg): initially ≤2g/night in 2 equally divided doses, at bedtime then again 2.5–4hrs later. May increase by 1g/night (0.5g/dose) at weekly intervals. Max total dose: 6g/night. (30–<45kg): initially ≤3g/night in 2 equally divided doses, at bedtime then again 2.5–4hrs later. May increase by 1g/night (0.5g/dose) at weekly intervals. Max total dose: 7.5g/night. (≥45kg): initially ≤4.5g/night in 2 equally divided doses, at bedtime then again 2.5–4hrs later. May increase by 1.5g/night (0.75g/dose) at weekly intervals; max total dose: 9g/night.	Take on empty stomach. Dilute each dose with 60mL of water. Some patients may respond better with unequal doses. Allow 6hrs before becoming active after last dose. Consider concomitant CNS stimulant use (see full labeling).
solriamfetol	Sunosi	CIV	75mg+, 150mg	tabs	Adults: Initially 75mg once daily; usual range 75–150mg/day. May double dose at intervals of ≥3 days; max 150mg/day. Renal impairment: CrCl 30–59mL/min: initially 37.5mg/day; may increase to max 75mg/day after ≥7 days. CrCl 15–29mL/min: initially and at max 37.5mg/day. CrCl <15mL/min: not recommended. Children: Not established.	Take upon awakening; avoid within 9hrs of planned bedtime.
NON-24-HOUR
tasimelteon	Hetlioz	Rx	20mg	caps	Adults: 20mg once daily before bedtime. Children: Not established.	Take at the same time every night. Avoid with food.
RESTLESS LEG SYNDROME
gabapentin enacarbil	Horizant	Rx	300mg, 600mg	ext-rel tabs	Adults: 600mg once daily at about 5pm with food. No additional benefit with 1200mg. Renal impairment: CrCl 30–59mL/min: initially 300mg/day and increase to 600mg as needed. CrCl 15–29mL/min: 300mg/day. CrCl <15mL/min: 300mg every other day. CrCl <15mL/min on HD: not recommended. Children: Not studied.	If dose not taken at recommended time, next dose should be taken the following day.
pramipexole	—	Rx	0.125mg, 0.25mg+, 0.5mg+, 0.75mg, 1mg+, 1.5mg+	tabs	Adults: Initially 0.125mg once daily 2–3 hrs before bedtime. May double dose every 4–7 days; max 0.5mg/day (doses of 0.75mg/day have been used). Renal impairment: increase titration interval to every 14 days if needed. Children: Not established.
ropinirole	—	Rx	0.25mg, 0.5mg, 1mg, 2mg, 3mg, 4mg, 5mg	tabs	Adults: Initially 0.25mg on Days 1 & 2, then 0.5mg on Days 3–7, increase by 0.5mg/day at 1-wk intervals to 3mg then may increase to 4mg after 1wk; max 4mg/day. ESRD on HD: initially 0.25mg/day; max 3mg/day. Children: Not established.	Take once-daily 1–3 hrs before bedtime. Titrate gradually.
NOTES
Key: + = scored; ER = extended-release; HD = hemodialysis; IR = intermediate-release; SL = sublingual ¹ Use lowest effective dose ² Contains tartrazine ³ Contains phenylalanine Not an inclusive list of medications, official indications, or dosing information. Please see drug monograph at www.eMPR.com and/or contact company for full drug labeling. (Rev. 9/2023)

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