Sedation with antipsychotics: Manage, don't accept adverse 'calming' effect
Current Psychiatry. 2007 August;06(08):39-51
August 1, 2007|Psychiatry
Author and Disclosure Information
Initiate the antipsychotic at a reasonable, not overly high dose, then use a nonantipsychotic to help control insomnia, anxiety, and agitation.
Table 4
Sedatives to treat insomnia in patients with schizophrenia
| Medication | Common bedtime dose range* |
|---|---|
| Benzodiazepines | |
| Estazolam | 1 to 2 mg |
| Flurazepam | 15 to 30 mg |
| Temazepam | 7.5 to 30 mg |
| Triazolam | 0.125 to 0.25 mg |
| Benzodiazepine agonists | |
| Eszopiclone | 2 to 3 mg |
| Zaleplon | 5 to 10 mg |
| Zolpidem | 5 to 10 mg |
| Zolpidem CR | 6.25 to 12.5 mg |
| Melatonin receptor agonist | |
| Ramelteon | 8 mg |
| H1 antihistamines | |
| Diphenhydramine | 25 to 50 mg |
| Hydroxyzine | 50 to 100 mg |
| Antidepressants | |
| Mirtazapine | 15 to 30 mg |
| Trazodone | 50 to 200 mg |
| * No dosage adjustment is required in this patient population | |
Related resources
- Miller DD. Atypical antipsychotics: sleep, sedation, and efficacy. Prim Care Companion J Clin Psychiatry 2004;6(suppl 2):3-7.
- Benca RM, Diagnosis and treatment of chronic insomnia: a review. Psychiatr Serv 2005;56(3):332-43.
Drug Brand Names
- Aripiprazole • Abilify
- Bupropion • Wellbutrin
- Carbamazepine • Tegretol
- Chlorpromazine • Thorazine
- Clozapine • Clozaril
- Diphenhydramine • Benadryl
- Estazolam • ProSom
- Eszopiclone • Lunesta
- Fluphenazine • Prolixin
- Flurazepam • Dalmane
- Haloperidol • Haldol
- Hydroxyzine • Vistaril, Atarax
- Lamotrigine • Lamictal
- Mirtazapine • Remeron
- Modafinil • Provigil
- Olanzapine • Zyprexa
- Quetiapine • Seroquel
- Ramelteon • Rozerem
- Risperidone • Risperdal
- Temazepam • Restor
- Trazodone • Desyrel
- Triazolam • Halcion
- Valproic acid • Depakote
- Zaleplon • Sonata
- Ziprasidone • Geodon
- Zolpidem • Ambien, Ambien CR
Disclosure
Dr. Miller receives research support from Pfizer Inc. and has received honoraria from AstraZeneca, Bristol-Myers Squibb, Janssen Pharmaceutica, and Pfizer Inc.
