Switching to different class* | Within-class switching* | Discontinuation best practices¶ | |
Benzodiazepines | |||
Estazolam Flurazepam Lorazepam Temazepam Triazolam | Slow taper method/cross taper | Direct switch |
|
Nonbenzodiazepine BZRAs | |||
Eszopiclone | Taper and then wait 1 to 2 days | Taper and then wait 1 to 2 days |
|
Zaleplon | Direct switch | Direct switch | |
Zolpidem | Taper and then wait 1 to 2 days | Taper and then wait 1 to 2 days | |
Dual orexin receptor agonists | |||
Daridorexant | Direct switch | Direct switch |
|
Lemborexant | Direct switch | Direct switch | |
Suvorexant | Direct switch | Direct switch | |
Other agents | |||
Doxepin 3 to 6 mg | Direct switch | N/A |
|
Ramelteon | Direct switch | N/A | |
Antidepressants | |||
Amitriptyline | Slow taper method/cross taper | Not recommended |
|
Mirtazapine | Slow taper method/cross taper | Not recommended | |
Trazodone | Slow taper method/cross taper | Not recommended |
BZRA: benzodiazepine receptor agonist; CBT-I: cognitive behavioral therapy for insomnia.
* Methods of switching are defined as follows:
¶ In general, people want to be informed of alternative strategies for managing their insomnia if they are being advised to stop their present hypnotic. The deprescribing plan may be more successful if the individual is fully educated about what to expect during discontinuation. The introduction of CBT-I may also be helpful in transitioning people off hypnotic medications.
Δ Refer to separately available content in UpToDate on switching and discontinuing antidepressant medications for more detailed recommendations.