> 4 Central nervous system > 4.1 Hypnotics and anxiolytics > 4.1.1 Hypnotics

4.1.1 Hypnotics

General guidance

Hypnotics should not be prescribed indiscriminately and routine prescribing is undesirable. They should be reserved for short courses.
Before a hypnotic is prescribed the cause of the insomnia should be established and, where possible, underlying factors should be treated.
Some patients have unrealistic sleep expectations, and others underestimate their alcohol consumption which is often the cause of the insomnia.
Hypnotics should be avoided in the elderly, who are at risk of becoming ataxic and confused, and so liable to fall.
Zolpidem and zopiclone appear to offer few advantages over benzodiazepines, and their use should therefore be avoided.

Please see the prescribing guidelines for Benzodiazepines in Adults

Recommended drugs

Slenyto (Melatonin 1mg, 5mg tablets slow release) - Treatment of insomnia in children with autism-spectrum disorders (ASD) and/or Smith-Magenis Syndrome (SMS) as per shared care agreement.

Drug Traffic Light Key:

Green – On Formulary

Amber – Restricted use, see local guidelines

Purple – Specialist use/initiation

Red – Non Formulary

Relative Costs Key (where indicated):

£££££ - high

£££ - moderate

£ - low

Insomnia - newer hypnotic drugs - NICE TAG TA77

1.1 When, after due consideration of the use of nonpharmacological measures, hypnotic drug therapy is considered appropriate for the management of severe insomnia interfering with normal daily life, it is recommended that hypnotics should be prescribed for short periods of time only, in strict accordance with their licensed indications.

1.2 It is recommended that, because of the lack of compelling evidence to distinguish between zaleplon, zolpidem, zopiclone or the shorter-acting benzodiazepine hypnotics, the drug with the lowest purchase cost (taking into account daily required dose and product price per dose) should be prescribed.

1.3 It is recommended that switching from one of these hypnotics to another should only occur if a patient experiences adverse effects considered to be directly related to a specific agent. These are the only circumstances in which the drugs with the higher acquisition costs are recommended.

1.4 Patients who have not responded to one of these hypnotic drugs should not be prescribed any of the others.

http://www.nice.org.uk/guidance/TA77

If considering benzodiazepines, please see the prescribing guidelines for Benzodiazepines in Adults