Clinical Medicine Reviews in Therapeutics

This review primarily focuses on the pharmacotherapy for insomnia, including current and emerging pharmacotherapy for insomnia. Currently, there are 10 FDA-approved drugs for the treatment of insomnia. The mainstay treatments are benzodiazepine receptor agonists, which are now available in controlled release formulation to support sleep maintenance. Melatonin receptor agonists are usually used for sleep initiation insomnia. Doxepin an antidepressant is approved for treatment of insomnia. Anticonvulsants and antipsychotics are used ‘off-label’ to treat insomnia, despite limited data to support its use. 5-HT2A serotonin receptor inverse agonists and orexin receptor antagonists are in Phase II and III clinical trials for insomnia with different mechanisms of action.

When treating insomnia patients, it is important to individualize treatment by considering various comorbid conditions. Further research is needed to evaluate the efficacy and safety of newly emerging medications, as well as medications that are frequently used without established clinical evidence.