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Selective melatonin agonists are indicated for insomnia characterized by difficulty with sleep onset, particularly for individuals who lack dim-light melatonin-onset stimulation.
Melatonin itself is not regulated by the US Food and Drug Administration (FDA) and is thus not approved for treatment of insomnia.
The extended-release product (Ambien CR) consists of a coated 2-layer tablet and is useful for insomnia characterized by difficulties with sleep onset and/or sleep maintenance.
The first layer releases drug content immediately to induce sleep; the second layer gradually releases additional drug to provide continuous sleep.
Medications used in the treatment of insomnia include nonbenzodiazepine receptor agonists, benzodiazepine receptor agonists, the selective melatonin receptor agonist ramelteon, and sedating antidepressants.
All can be considered first-line agents for insomnia; agent choice is largely dictated by past trials, cost, side-effect profile, drug interactions, and patient preference.
A sedative-hypnotic of the imidazopyridine class, zolpidem has a rapid onset and short duration of action.
It is a good first choice for treatment of sleep-onset insomnia and produces no significant residual sedation in the morning.
Fentanyl (Brand name: Sublimaze) is an opiod, a medicine in the same family as Morphine.
Melatonin does not appear to have obvious side effects other than sedation.
Currently, ramelteon is the only melatonin receptor agonist approved by the FDA for treatment of insomnia and is available by prescription.
This medication is a Benzodiazepine, it belongs to the same family as Valium, and it can be given orally or intravenously.
Midazolam may be given by itself to help a child relax or in combination with other medications to help a child sleep through a test or procedure.
The higher-dose sublingual product (Edluar) is available as 5- and 10-mg tablets; an oral spray (Zolpimist) is also available for sleep-onset and/or sleep-maintenance insomnia.