Z-drugs (zolpidem / eszopiclone / zaleplon)
Sleep · GABA-A alpha-1 positive modulators
Tier B
What this is
FDA 2019 black-boxed complex sleep behaviors after deaths from sleep-driving/sleep-related activities. Historically used chronically despite short-term approval. Tolerance develops within weeks; withdrawal insomnia returns upon discontinuation. Newer DORAs generally preferred where cost allows.
Mechanism
Preferentially bind GABA-A receptor alpha-1 subunit (vs benzodiazepines which bind multiple); shorter half-life; FDA-approved for short-term insomnia; 'complex sleep behaviors' black box
Dose & route
Zolpidem 5-10 mg; eszopiclone 1-3 mg; zaleplon 5-20 mg PO at bedtime
Citations
- https://pubmed.ncbi.nlm.nih.gov/31105128/
- https://pubmed.ncbi.nlm.nih.gov/23046547/
- https://pmc.ncbi.nlm.nih.gov/articles/PMC3074707/
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