4.1.1 Hypnotics - for short term use only
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Try to avoid. If needed, use for 1-3 days only. Do not give on discharge from hospital. Hypnotics are only licensed for short
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| term use. On specialist advice only, some patients with long term psychiatric problems may require long term use. |
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GREEN Temazepam
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| tablets 10mg |
| elixir 10mg/5mL |
| AMBER Nitrazepam |
| tablets 5mg |
| oral suspension 2.5mg/5mL |
| GREEN Zopiclone tablets 3.75mg, 7.5mg |
| GREEN Zolpidem tablets 5mg, 10mg - in line with NICE TA 77- short term use only. |
| RED Melatonin 2mg MR tablets - for use in ICU only |
| BLACK Promethazine tablets 10mg, 25mg, liquid 5mg/5mL |
| NOTE: Promethazine should not be prescribed as a hypnotic. This is a non-formulary indication (BLACK) consistent |
with the advice in the BNF that has determined that promethazine is “less suitable for prescribing"
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| |
| Chloral Hydrate for paediatric sedation |
| RED Chloral hydrate liquid 500mg/5mL |
| |
| Melatonin [Circardin® tablets] - See Shared Care Guideline |
| Melatonin PR tablets, off license use, for the treatment of sleep disorders in children aged 2 - 18 years with |
neurodevelopmental disorders.
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| The long term safety and efficacy of melatonin is unclear. |
| AMBER Shared Care Melatonin 2mg [Civasta ® MR tablets 2mg, Circardin® prolonged release tablets] [off label use] |
| AMBER Melatonin tablets 3mg [Ceyesto tablets] for paediatric use only, |
| with ongoing monitoring and sleep diaries. |
| |
| SEE: Melatonin Pathway (Children) - click here |
| |
| Melatonin in the Treatment of Rapid Eye Movement [REM] Sleep Behaviour Disorder [RBD] in Parkinson's Disease and |
Lewy Body Dementia
|
| Melatonin prolonged release tablets [Circardin®] are suitable for prescribing in primary care following initiation or |
| recommendation by a specialist when clonazepam is not considered appropriate. |
| AMBER Melatonin prolonged release tablets 2mg [Circardin®] |
| |
| NICE TA922 Daridorexant (Quiviviq®) |
| 1.1 Recommended for treating insomnia in adults with symptoms lasting for 3 nights or more per week for at least |
3 months, and whose daytime functioning is considerably affected, only if:
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| > cognitive behavioural therapy for insomnia (CBTi) has been tried but not worked, or |
| > CBTi is not available or is unsuitable. |
| 1.2 The length of treatment should be as short as possible. Treatment with daridorexant should be assessed within 3 |
| months of starting and should be stopped in people whose long-term insomnia has not responded adequately. |
| If treatment is continued, assess whether it is still working at regular intervals. |
| GREEN (restricted) Daridorexant tablets 25mg, 50mg (Quiviviq) |
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| Sodium oxybate for treatment of narcolepsy with cataplexy in adults (under expert supervision) |
| RED Sodium oxybate 500mg/mL oral solution [Xyrem®] |
| Specialist medicine |
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| BACK to main chapter |
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4.1.2 Anxiolytics
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Use at lowest dose for shortest time possible. Long term use should be avoided except on specialist advice.
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Chlordiazepoxide is also used in a reducing dose regimen for the management of acute alcohol withdrawal.
| GREEN Chlordiazepoxide | capsules 5mg, 10mg
| |
| GREEN Diazepam |
| tablets 2mg, 5mg, 10mg |
| syrup 2mg/5mL |
| injection 10mg/2mL |
| suppositories 10mg |
| GREEN Lorazepam tablets 1mg |
| RED Lorazepam injection 4mg/mL |
| RED Promethazine tablets 10mg, 25mg, liquid 5mg/5mL [for short term use in anxiety only] |
| NOTE: Promethazine should not be prescribed as a hypnotic. This is a non-formulary indication (BLACK) consistent | | with the advice in the BNF that has determined that promethazine is “less suitable for prescribing" | |
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| BACK to main chapter |
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