Insomnia: A therapeutic review for pharmacists

OBJECTIVE: To review the literature for the management of insomnia. DATA SOURCE: MEDLINE/PUBMED searches (January 1950-June 2010) were conducted to identify pertinent English-language studies. STUDY SELECTION AND DATA EXTRACTION: All studies evaluating aspects of the treatment of insomnia. DATA SYNTHESIS: Insomnia is a major public health problem requiring effective diagnosis and treatment. Treatment options include cognitive behavioral therapy as well as pharmacologic therapy. Benzodiazepine receptor-agonist modulators are considered first-line therapy in the treatment of chronic insomnia. A nonbenzodiazepine receptor-modulator option to improve sleep latency is ramelteon. Low-dose sedative antidepressants, such as quetiapine or olanzapine, may be used in the treatment of comorbid insomnia. Over-the-counter and herbal agents are not recommended. CONCLUSION: Numerous medications being used in the management of insomnia have side effects that can limit their use and have a potential for drug interactions. Furthermore, some medications used in the treatment of insomnia do not have clinical trial data to support their use. Future studies are warranted to define second- and third-line agents in the management of insomnia.