Two drugs that are not licensed to treat insomnia performed well in adults with acute and long-term condition, researchers report today.
Research by the University of Oxford, UK, into the pharmacological management of insomnia is the largest of its kind to date and involved 154 double-blind trials including 44,000 people randomised to one of 30 licensed or not licensed drugs, or placebo.
Writing in *The Lancet*, the study revealed eszopiclone and lemborexant were best performers.
Professor Andrea Cipriani, professor of psychiatry and honorary consultant psychiatrist at Oxford Health NHS Foundation Trust, led the research to estimate the effectiveness of pharmacological treatments for the acute and long-term treatment of adults with insomnia disorder, where the condition is not accompanied by a mental health co-morbidity, such as depression or physical illness.
Study participants were assessed on their quality of sleep, the effects of treatment discontinuation, and the presence of any adverse events, such as dizziness, nausea, fatigue, headache, sedation and somnolence.
“This study of pharmacological treatments is not a recommendation that drugs should always be used as the first line of support to treat insomnia, not least because some of them can have serious side effects,” said Professor Cipriani.
“However, our research shows that some of these drugs can also be effective, and should be used in clinical practice, when appropriate. For example, where treatments such as improved sleep hygiene and Cognitive Behavioural Therapy have not worked, or where a patient wants to consider taking medication as part of their treatment.”
Although the study identified that eszopiclone could be effective as an insomnia treatment, side effects could include dizziness and nausea, while safety data on lemborexant were inconclusive, although there was a higher risk of headache.
Other findings suggest there was insufficient evidence to support the prescription of benzodiazepines and zolpidem in the long-term treatment for insomnia.
Co-author Professor Philip Cowen, professor of psychopharmacology, said: “It should also be noted that the drug lemborexant acted via a different pathway in the brain – the orexin neurotransmitter system – a relatively novel mechanism of action. More selective targeting of this pathway and orexin receptors could lead to better pharmacological treatments for insomnia.”
Comparative effects of pharmacological interventions for the acute and long-term management of insomnia disorder in adults: a systematic review and network meta-analysis. *Lancet* 15 July 2022
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