Review, Sep/20: New pharmacologic agents for insomnia and hypersomnia

"New pharmacologic agents for insomnia and hypersomnia"

 

https://pubmed.ncbi.nlm.nih.gov/32890017/

 

 

Abstract

 

Purpose of review: Insomnia and hypersomnia are conditions with multifactorial causes that can be difficult to treat. There have been recent developments and changes in the treatment of both conditions, including the addition of some agents that have a novel mechanism of action. This review summarizes recent changes and highlights pertinent updates.

 

Recent findings: Benzodiazepine receptor agonists received a warning in 2019 regarding the possibility of complex sleep behaviors, such as sleepwalking. Zolpidem has been marketed in new dosage forms that include sublingual tablets and oral spray formulations. Orexin receptor antagonists appear to be well tolerated with a good safety profile. Suvorexant received an approval for the treatment of patients with comorbid insomnia and dementia. Lemborexant was demonstrated to be effective for maintenance insomnia. Trazodone was shown to affect the oligomerization of tau proteins thus suggesting potential implications in attenuating dementia pathology. Pitolisant, a novel histamine-3 receptor antagonist/inverse agonist, gained approval for the treatment of excessive daytime sleepiness in adults with narcolepsy as well as obstructive sleep apnea. Solriamfetol, a new norepinephrine and dopamine reuptake inhibitor, was approved for hypersomnolence based on good efficacy, but with cardiovascular warnings.

 

Summary: Recent advancements in the treatment of insomnia includes agents with novel mechanisms, new indications, and new dosage forms. Risk of complex sleep behaviors, and possible next-day driving impairment, should be discussed for all agents used for insomnia, including orexin receptor antagonists. Novel agents also are available for hypersomnia and there are options beyond traditional stimulants that may have great utility.

Thanks, Lapis. But I find this all very distressing. Zolpidem, for me, was a hard to get off as benzos. Indeed, they are kissing cousins. And no mention of dependence/addiction, tolerance, withdrawals, and all the other good things that come with a drug that messes with your gaba.

 

How about a nice double-strength cup of chamomile tea? That worked better for me than any prescription drug and lord knows, I tried them all. The OTC preparations, too. CBD mj works well, also, I found. Sigh. But no one's getting rich from tea or weed, are they? Sorry if I sound jaded.

 

Thanks for your continuing efforts, Lapis. Hope you are doing okay.

 

 

Katz

 

 

Ah, Katz, yes...I know. But I'm not surprised to see things like this. People will always want medication for whatever ails them, be it insomnia or hypersomnia. Perhaps one of these meds might be less problematic than the things we took, but of course, all meds come with possible side effects. It goes without saying. Hopefully, patients will receive appropriate information about those possible side effects BEFORE they start taking something, though.

"New pharmacologic agents for insomnia and hypersomnia"

 

https://pubmed.ncbi.nlm.nih.gov/32890017/

 

 

Abstract

 

Purpose of review: Insomnia and hypersomnia are conditions with multifactorial causes that can be difficult to treat. There have been recent developments and changes in the treatment of both conditions, including the addition of some agents that have a novel mechanism of action. This review summarizes recent changes and highlights pertinent updates.

 

Recent findings: Benzodiazepine receptor agonists received a warning in 2019 regarding the possibility of complex sleep behaviors, such as sleepwalking. Zolpidem has been marketed in new dosage forms that include sublingual tablets and oral spray formulations. Orexin receptor antagonists appear to be well tolerated with a good safety profile. Suvorexant received an approval for the treatment of patients with comorbid insomnia and dementia. Lemborexant was demonstrated to be effective for maintenance insomnia. Trazodone was shown to affect the oligomerization of tau proteins thus suggesting potential implications in attenuating dementia pathology. Pitolisant, a novel histamine-3 receptor antagonist/inverse agonist, gained approval for the treatment of excessive daytime sleepiness in adults with narcolepsy as well as obstructive sleep apnea. Solriamfetol, a new norepinephrine and dopamine reuptake inhibitor, was approved for hypersomnolence based on good efficacy, but with cardiovascular warnings.

 

Summary: Recent advancements in the treatment of insomnia includes agents with novel mechanisms, new indications, and new dosage forms. Risk of complex sleep behaviors, and possible next-day driving impairment, should be discussed for all agents used for insomnia, including orexin receptor antagonists. Novel agents also are available for hypersomnia and there are options beyond traditional stimulants that may have great utility.

 

Nothing new in this article.

I agree with Katz! Thx Lapis for this post.

I wish I could drag those pharmaceuticals, doctors and fda to my house to spend just one day with me! Ambien ( zolpidem) is the ONLY medicine I've ever taken. Because of it, I'm bedridden like an old lady on her death bed. The Z drugs are JUST AS harmful, if not worse in some aspects because of their very short half lives and hard hit impact on the brain. All they did was took a benzo altered it a bit and sold it as a " safe" sleeping pill. That means people like me unknowingly took benzo. NEVER was I instructed to take only for 2 weeks or less. NEVER was told not to take every night. NEVER warned about tolerance, dependence or brutal debilitating withdrawals. NEVER even suggested that I need to taper off. Ruined my life! I'm praying that something is swiftly done about dispensing benzos & z drugs. Something other than revising a warning.