4.1 Hypnotics and anxiolytics

4.1.1 Hypnotics

BNF Hypnotics and anxiolytics

1st      ZOPICLONE     
1st     ZOLPIDEM    
1st     MELATONIN    Melatonin is currently licensed for primary insomnia in patients over 55 years
2nd     TEMAZEPAM      The CD regulations attached to temazepam can cause logistical problems
      NITRAZEPAM   - should be prescribed for continued treatment only
            Treat the cause of insomnia (e.g depression, pain) before resorting to hypnotic
            Use in short courses only (intermittently for no more than a few days) when insomnia is severe, disabling, or subjecting the individual to extreme distress
            Tolerance develops within 3 to 14 days
            Chronic insomnia may be due to depression. If antidepressant appropriate, consider using one with sedative properties e.g amitriptyline, trazodone or mirtazapine

4.1.2 Anxiolytics

NICE CG113 - Generalised anxiety disorder and panic disorder (with or without agoraphobia) in adults: Management in primary, secondary and community care Jan 2011

1st      DIAZEPAM      
1st     LORAZEPAM    The maximum licensed daily dose of lorazepam has now been reduced to 2mg in severe disabling insomnia, and 4mg for the short term symptomatic treatment of severe disabling anxiety.
2nd     BUSPIRONE (Yellow)    Buspirone must be initiated within psychiatry only. Use for short term relief of severe, disabling anxiety. Beware of tolerance and dependence. Consider SSRI for various anxiety disorders (see 4.3.3) 
      CHLORDIAZEPOXIDE (alcohol detoxification only)    


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