Place in therapy
Doxylamine usual dose is 25mg 30 minutes prior to sleeping.1 Combination products should not be recommended except in the case of Diclectin for pregnant women. It has been shown to decrease sleep latency, night time awakenings and improve the duration of sleep. This drug is effective for the short term treatment of insomnia (7-10 days) and no more than 2-4 times weekly.2 Tolerance to the sedation effect of anti-histamines make them undesirable for long term use. Its hypnotic effect is similar to phenobarbital and flurazepam. It should be noted that only a handful of studies were performed on this medication and the evidence is limited however, because of its longer half-life, the morning hangover effect may be worse compared to diphenhydramine (which has similar efficacy and has been studied more extensively)3. Other adverse effects of this drug include the anticholinergic effects and because of this should be avoided in the elderly. Furthermore, this drug should be avoided in those with glaucoma, asthma, enlarged prostate, difficulty urinating and those with thyroid problems.1 The use of this agent in pediatrics for insomnia is not well studied and should not be recommended for this patient population. This is the drug of choice for the pregnant population where the safety of this drug has been thoroughly established and has low teratogenic risk. This drug does not cross into the breastmilk at detectable levels caution should still be taken on the histaminic effects on the infant.4
References
1. Doxylamine. Lexi-comp. 2012 (www.lexi-comp.com). Retrieved July 12, 2012.
2. Vaillancourt, R. Insomnia. Patient Self Care 1st edition. 2002. CPhA; Ottawa 52-54.
3. Randall S, Roehrs T and Roth, T. Over-the-Counter Sleep Aid Medications and Insomnia. Clinical Focus. Primary Psychiatry. 2008; 15 (5):52-58.
4. Alesky J and Smith M. Sedatives and hypnotics in Lactation. The Journal of human Lactation. 1998;14 (1):61-65.
.
Doxylamine usual dose is 25mg 30 minutes prior to sleeping.1 Combination products should not be recommended except in the case of Diclectin for pregnant women. It has been shown to decrease sleep latency, night time awakenings and improve the duration of sleep. This drug is effective for the short term treatment of insomnia (7-10 days) and no more than 2-4 times weekly.2 Tolerance to the sedation effect of anti-histamines make them undesirable for long term use. Its hypnotic effect is similar to phenobarbital and flurazepam. It should be noted that only a handful of studies were performed on this medication and the evidence is limited however, because of its longer half-life, the morning hangover effect may be worse compared to diphenhydramine (which has similar efficacy and has been studied more extensively)3. Other adverse effects of this drug include the anticholinergic effects and because of this should be avoided in the elderly. Furthermore, this drug should be avoided in those with glaucoma, asthma, enlarged prostate, difficulty urinating and those with thyroid problems.1 The use of this agent in pediatrics for insomnia is not well studied and should not be recommended for this patient population. This is the drug of choice for the pregnant population where the safety of this drug has been thoroughly established and has low teratogenic risk. This drug does not cross into the breastmilk at detectable levels caution should still be taken on the histaminic effects on the infant.4
References
1. Doxylamine. Lexi-comp. 2012 (www.lexi-comp.com). Retrieved July 12, 2012.
2. Vaillancourt, R. Insomnia. Patient Self Care 1st edition. 2002. CPhA; Ottawa 52-54.
3. Randall S, Roehrs T and Roth, T. Over-the-Counter Sleep Aid Medications and Insomnia. Clinical Focus. Primary Psychiatry. 2008; 15 (5):52-58.
4. Alesky J and Smith M. Sedatives and hypnotics in Lactation. The Journal of human Lactation. 1998;14 (1):61-65.
.