King; patent expires June 2008.
Indicated for sleep initiation but not for sleep maintenance.
A so-called “non-benzodiazepine,” in the chemical category called “pyrazolopyridines.” Binds to the GABA-benzodiazepine receptor complex, like benzodiazepines, but is more selective for the omega-1 receptor subtype than BZs.
Supplied as 5 mg and 10 mg capsules (not breakable).
Start at 5 mg QHS for elderly, 10 mg QHS otherwise. The PDR suggests a maximum of 20 mg QHS.
Most common: drowsiness and dizziness.
Because of Sonata’s short half life, it rarely causes next day impairment.
Does not impair normal sleep stages.
Classified as a Schedule IV drug, but abuse potential is likely somewhat less than BZs.
Pregnancy Category C
Additive effect when combined with alcohol and other drugs or medications that have sedative effects.
Cytochrome P450 3A4 inducers, such as tegretol, may significantly decrease Sonata blood levels.
Cimetidine increases Sonata levels by 80%.
Half life is 1 hour; duration of action about 4 hours.
No active metabolites. Metabolized in the liver by aldehyde oxidase.
Absorbed more slowly if taken after a meal.
Cut dose in half in hepatic insufficiency. No adjustments needed in renal impairment.
Great for inducing sleep, not great for sleep maintenance throughout the night. Only sleeping pill that can be taken at 3 or 4 AM without causing functional impairment when the patient gets out of bed at 7 or 8 AM.