*For medical professionals for reference
Drug treatment is an important part of insomnia treatment. Lets see what are the insomnia drugs.choose?
Writing: Lu Xiong
Insomnia is one of the most common sleep problems.Long -term insomnia affects the normal life and work of the individual, and increases the risk of various health problems.Drug treatment is an important part of insomnia treatment. Lets take a look at what choices of insomnia drugs?
The principle of drug treatment [1]
Drug treatment mainly refers to sedative hypnotic drugs.The cause of insomnia should be treated with targeted treatment and should also avoid or reduce related negative effects.Grassroots medical institutions need to follow the following principles:
Figure: Drug treatment of insomnia process
: China Adult Insomnia Diagnosis and Treatment Guide (Edition 2023)
1. Time opportunity: Unable to conduct cognitive behavior therapy (CBTI) or unwilling to accept CBTIAnd when CBTI is dissatisfied, you can decide with patients to choose drug treatment; for patients with severe insomnia symptoms and urgent patients, they should be applied as soon as possible.CBTI is a multi -component non -drug treatment for insomnia caused by behavior and cognitive factors, including sleep health education, sleep restriction treatment, stimulating control treatment, cognitive treatment, and relaxation training.
2. Individualization: Consider the characteristics of the patients symptoms, such as difficulty sleeping, maintaining difficulties in sleep or waking up early, paying attention to physical diseases, spiritual spiritual diseases, spiritObstacles, sleep disorders, drugs and (or) the history of addictive substances, interaction of drugs, and patients self -choice and drug acquisition.
3. Drug on demand and intermittently: Start treatment at the lowest dose and gradually drip up to achieve the treatment effect.The specific decision -making criteria of "on demand": When it is difficult to fall asleep, take it 5 ~ 10 min before going to bed; when you cant fall asleep after going to bed, take it immediately;You can take a short half -life drug; take the next days day activity (such as important affairs) and take it before going to bed."Intermittent" refers to non -continuous medication every night, and the specific frequency is not conclusive. The recommended frequency is 3 to 5 nights/week.
4. Treatment: The course of treatment is determined by the course of insomnia, severity, and treatment of drugs, generally not more than 4 weeks; if continuous treatment exceeds 4 more than 4It is necessary to re -evaluate it during the week.For those who have poor efficacy and safety, it is recommended to replace the treatment of drugs. Those with obvious sleep will be replaced. It is recommended to take dose or intermittent administration in a timely manner.
5. Termination of treatment: After the patients insomnia improves and feels that you can control sleep, you can consider gradually decrease and stop the drug. CBTI will help this process.EssencePatients with large doses, multi -drug combination, or long -term continuous drug treatment should avoid sudden drug discontinuation to avoid insomnia, seizures, and other severe mental symptoms.
6. Special crowd: Children, pregnant women, lactating women, liver and kidney dysfunction, severe sleep apnea syndrome, severe severe muscle weakness patients use with caution.Severaous hypnotic drug treatment.
The choice of insomnia drugs [2]
Drug treatment of insomnia includes phenolin nitrodicin receptor excitement excitementBZRAS, double appetite receptor antagonist (DORA), melatonin and melatonin receptor agonist, antibody amine H1 receptor drug, antidepressant drugs, antidepressant drugs and BZRAS combinationApplication, anti -psychiatric drugs and anesthesia drugs with sedative effects.
1.BZRAS, Divided into phenyl nitrogen pyrine (BZDS), non-phenyl nitrogen drugs (NON-BZDS) and new benzene benzeneTwo nitrogen receptor agonists. BZDS: It can improve sleeping difficulties in patients with insomnia and increase total sleep time.Totazole is a short half -life hypnotic drug. BZDS, which is commonly used in China to treat insomnia, also includes Azimazo, Apzolon, Laurax, Dixi, Osari, and chlorolgia. NON-BZDS: mainly includes Pippin, Thal Polon, Youzopeton and Sagon.The new type of phenyl nitrogen receptor agonist Disadida peak time is about 1 h and the half -life is about 4 h. It is suitable for sleeping difficulties and maintaining difficulties in sleep. It can improve daily fatigue without affecting the daily function.
2. Double appetite receptor antagonist .Three dual -appetitein receptor antagonists (DORA) drugs that have entered the clinic include: Suvreron, Ledu Leison, and Daliramon. Dora can significantly improve the subjective sleep time, total sleep time, extend the duration of the fast eyeball (REM) sleep, and improve the sleep structure and sleep quality. Suvorrenson The dose is 10 mg or 20 mg, orally before bedtime, the peak time is generally 2.0 ~ 3.5 h, and the half -life is 12-15 h.The Robred dose is 5 mg or 10 mg, the peak time is generally 1 ~ 3 h, and the half -life is 17 ~ 19 h. Dali Leisheng The dose is 25 mg or 50 mg, orally 30 min before going to bed, the peak time is generally 1 ~ 2 h, the half -life is 8 h, the common dose is 50 mg, the special group daily25 mg.
3. Melocar and melatonin receptor agonist .Melalemmacon slow release tablets (2 mg) were approved in Europe for insomnia for insomnia over 55 years of age.The commonly used administration method and dose are 2 ~ 3 h before going to bed to take 0.3 ~ 5.0 mg.The melatonin receptor agonist includes Relimine (Rymeitton) and Tesmeltong (other Simiqiong), which can shorten the sleep incubation period, improve sleep efficiency, and increase the total sleep time.The insomnia that mainly shows the difficulty of sleeping.
4. Antimamines H1 receptor drugs .Dorramin: The H1 antihistamine of ethanlamine type has a sedative effect and can shorten the sleeping period of sleep and is used for acute insomnia.The recommended dose is 7.5 ~ 25.0 mg, the peak time is 2 h, and the half -life is about 10 h.Benzira: Deriner of ethanlamine.Benzenhara Ming, as a non -prescription H1 anti -group amine, is used for the treatment of pregnancy and vomiting, and can also improve the insomnia of patients with pregnancy. The recommended dose is 25 ~ 50 mg before bedtime.
5. Anthaochemical drugs with sedative effects .Dori Ping: Taking small doses of Desai Ping (3 ~ 6 mg/d) is taken on an empty stomach, which is significantly delayed due to the half -life affected by food.It has obvious antihistamines and is used to treat insomnia characterized by sleep maintenance difficulties.It can improve the sleep of patients with chronic insomnia in adults and elderly, and use cautiously with corner glaucoma or urine retention patients.Totidone: Small dose quantic sonzolone (25 ~ 150 mg/d), administration 1 h before going to bed, can antagonize 5-hydroxylidin 2A receptor, center α1 receptor and H1 receptor, shorten the sleeping period, reduce sleep during sleep, reduce sleep during sleepThe number of awakening times, increasing sleep maintenance time, can increase slow wave sleep, thereby playing a sedative and hypnosis, which will not cause driving to sleep during the day.Mitang: 3.75 ~ 15.00 mg of rice nitrogen can quickly calm down, improve sleep, increase slow wave sleep, and help sustain sleep.
6. Anti -depression drugs and BZRAS combined applications .Early combined application of SSRI, 5-hydroxyline Corinning inhibitors (SNRI) and short-acting BZRAS (such as Pippin, Saspikon or Youzopon) can quickly relieve insomnia and improvePatients dependence on SSRI and SNRI.Tyzoline hydrochloride can improve the sleep structure and sleep continuity, and combined with short -acting BZRAS (such as Pippin, Saspicon, or Pitpirlon) to improve dependence.
7. Anti -psychiatrist with a sedative effect .Some anti -psychiatric drugs have a sedative effect due to the antihistamine mechanism, such as: sulfur flat, octophyla, and equality. These drugs can increase the total sleep time, improve the sleep structure, and reduce the awakening time in sleep.Considering its adverse reactions, there is still lack of evidence of evidence based on evidence, and insomnia patients without mental illness use such drugs.
8. Anesthesiomy .Right Meitomi must significantly improve sleep efficiency and increase N2 sleep.The right Mito Metimdins infusion is mainly used for the treatment of patients with severe and cure insomnia when the treatment is ineffective. It is necessary to conduct multiple disciplines such as neurology, psychiatry, respiratory, and anesthesia.application.The nasal suction right Metomy will shorten the sleep time, extend sleep time, and improve anxiety. However, the drug treatment is still a super adaptive certificate for insomnia.Owo infusion may be enhanced by enhancing the function of GABAA and glycine receptors, inhibiting the function of N-methyl-D-dilateine receptor, regulating sleep balance in the body, increasing slow wave sleep and improving depression.
Figure: Summary of pharmacokinetic characteristics, usage dosage, adaptation and adverse reactions of common insomnia treatment drugs
Source: Chinese Adult Insomnia Diagnosis and Treatment Guide (2023)
References:
[1]. Diagnosis and therapy of Chinese experts in the diagnosis and therapy of insomnia in grassroots medical institutions, Chinese Medical Journal, 2024,104 (25): 2296-2307.
[2]. Chinese adult adult insomnia diagnosis and treatment guide (2023), Chinese neurology magazine, 2024, 57 (6): 560-584.
Responsible editor: Old Bean Gear
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