4.1. Hypnotics and anxiolytics
4.1.1.1. Hypnotics for acute insomnia
Prescribing Notes:
Before a hypnotic is prescribed, the cause of the insomnia should be established and underlying factors should be addressed and non-drug management, such as sleep hygiene considered. If a hypnotic is essential, it should be prescribed at the lowest effective dose as a short course (preferably one week) and the choice of agent based on the patient’s medication and medical history and evaluation of the consequences of supplying a potential drug of abuse.
Restrictions:
Restricted to initiation as recommended by secondary care and in concordance with the NHSGGC 'Melatonin for acute and chronic insomnia in adults' treatment guideline.
Melatonin should be prescribed in generic form. Approved medicinal forms include:
- Melatonin 2mg modified-release tablets
- Melatonin 3mg modified-release tablets
- Melatonin 1mg in 1ml oral solution
Prescribing Notes:
Before a hypnotic is prescribed, the cause of the insomnia should be established and underlying factors should be addressed and non-drug management, such as sleep hygiene considered. If a hypnotic is essential, it should be prescribed at the lowest effective dose as a short course (preferably one week) and the choice of agent based on the patient’s medication and medical history and evaluation of the consequences of supplying a potential drug of abuse.
4.1.1.2. Hypnotics for chronic insomnia
Restrictions:
Restricted to use in patients where sleep hygiene advice has been unsuccessful and the use of cognitive behavioural therapy for insomnia (CBT-I) has failed or for whom CBT-I is unsuitable or unavailable.
Prescribing Notes:
- For the treatment of adult patients with chronic insomnia characterised by symptoms present for at least 3 months and considerable impact on daytime functioning.
- Sleepio® is a six-week programme based on CBT-I. Sleepio® is used to treat insomnia and is available free on the NHS. For more information visit Sleep | NHS inform
Restrictions:
Restricted to initiation as recommended by secondary care and in concordance with the NHSGGC 'Melatonin for acute and chronic insomnia in adults' treatment guideline.
Prescribing Notes:
Melatonin should be prescribed in generic form. Approved medicinal forms include:
- Melatonin 2mg modified-release tablets
- Melatonin 3mg modified-release tablets
- Melatonin 1mg in 1ml oral solution
4.1.2. Anxiolytics
Prescribing Notes:
Only beta-blocker licensed for anxiety with symptoms such as palpitation, sweating and tremor. It is not included in the Preferred List for hypertension, angina and heart failure