Table 1: Benzodiazepines and Hypnotic Agents Generic and Brand Names Initial Dosage
Maximum Dosage
Major Adverse Effects
Benzodiazepines Alprazolam (Xanax)
0.125 to 0.25 mg twice per day
0.25 to 2 mg twice per day
Lack of coordination, cognitive impairment, depression, drowsiness, fatigue, irritability, lightheadedness, sedation, appetite changes, weight loss or gain, constipation, dry mouth, difficulty urinating, dysarthria
Lorazepam (Ativan)
0.25 to 0.5 mg twice per day 10 mg twice per day
0.5 to 4 mg twice per day Sedation and respiratory depression
Oxazepam (Serax)
10 to 30 mg twice per day Edema, drowsiness, ataxia, dizziness, memory impairment, headache, paradoxical excitement, incontinence, blood dyscrasia, jaundice, dysarthria, tremor, diplopia, syncope (rare)
Temazepam (Restoril) 7.5 mg at night
5 to 7.5 mg at night
Confusion, dizziness, drowsiness, fatigue, anxiety, headache, lethargy, hangover, euphoria, vertigo, diarrhea, dysarthria, weakness, blurred vision, diaphoresis
Hypnotic Agents Eszopiclone (Lunesta) 1 to 2 mg at bedtime
1 to 2 mg at bedtime
Headache, unpleasant taste
Gabapentin (Neurontin) Mirtazapine (Remeron) Nortriptyline (Pamelor)
100 mg at bedtime 100 to 300 mg/3,600 mg at bedtime
Somnolence, dizziness, ataxia, fatigue, peripheral edema, diarrhea, tremor, weakness, nystagmus, diplopia
7.5 mg at bedtime 7.5 to 45 mg at bedtime Somnolence, increased appetite with weight gain, increased serum cholesterol, constipation, dry mouth
10 to 25 mg at bedtime
10 to 100 mg at bedtime Orthostasis, hypertension, myocardial infarction,
ataxia, extrapyramidal symptoms, seizures, glucose dysregulation, syndrome of inappropriate antidiuretic hormone, sexual dysfunction, dry mouth, anorexia, constipation, nausea, vomiting, diarrhea, weight gain (or loss), urinary retention, impotence, blood dyscrasia, increased levels in liver function test values, paresthesia, mydriasis
Trazodone (Desyrel)
25 mg at bedtime 25 to 200 mg at bedtime Orthostasis, ventricular irritability, sedation, dizziness, gait instability, mild cognitive impairment, seizures, weight gain, priapism, headache, dry mouth, edema, nausea, diarrhea
Zaleplon (Sonata)
5 mg at bedtime 5 to 10 mg at bedtime
Few common adverse effects Less common effects: Chest pain, edema, amnesia, dizziness, hallucinations, lightheadedness, incoordination, anorexia, dyspepsia, nausea, constipation, dry mouth, tremor, weakness, arthralgia Few common adverse effects Less common effects: Palpitations, headache, dizziness, lightheadedness, amnesia, nausea, diarrhea, dry mouth, constipation
Zolpidem (Ambien)
5 mg at night
5 to 10 mg at night
Antidepressants In adults, antidepressants are generally prescribed for insomnia, depressive disorders, anxiety disorders, and/or depression with comorbid anxiety. Selective Serotonin Reuptake Inhibit (SSRIs) are frequently prescribed as first-line treatment in adults due to their more benign side effects compared to other classes. However, the sensitivity to SSRI adverse effects is reportedly higher in adults compared to other population demographics. Of the SSRIs, preferred first-line choices generally include citalopram (Celexa), escitalopram (Lexapro), and sertraline (Zoloft). Second-line choices include fluoxetine (Prozac) and paroxetine (Paxil, Paxil CR), as well as the atypical antidepressant drugs venlafaxine (Effexor, Effexor XR) and bupropion (Wellbutrin, Wellbutrin SR, Wellbutrin XL). The older generation of antidepressants, tricyclic antidepressants, are also used in the adult population, especially for conditions where SSRI response is poor. The common side effects of TCAs in adults include psychomotor retardation; postural hypotension; and anticholinergic effects, which may cause blurred vision and cognitive impairment (Table 2).
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