Drug class | Examples | Bottom line |
Nonprescription medications | ||
Antihistamines |
| Consider for short-term situational and/or occasional use in younger children, especially those with comorbid atopic disease. |
Melatonin |
| Most appropriately used in patients with circadian phase delay. It is also a reasonable choice for children with sleep-onset insomnia who may need long-term pharmacotherapy, including those with ASD or ADHD. |
Prescription insomnia drugs | ||
Benzodiazepines |
| Limited utility in pediatric populations; other properties (eg, anxiolytic, long duration of action) may be useful in some patients. |
Nonbenzodiazepine receptor agonists |
| Lack of documented efficacy and sleep-related behavior side effects limit utility, except in older adolescents. |
Drugs with limited pediatric experience | ||
| Ramelteon may be a reasonable choice for mild sleep-onset insomnia, especially with circadian component, but cost and lack of insurance coverage limits use. | |
Drugs used off-label for insomnia | ||
Alpha-adrenergic agonists |
| These agents are commonly prescribed for childhood insomnia. Although there are few data to support this use, clinical experience suggests they are generally effective and well tolerated in ADHD. |
Antidepressants |
| Likely most useful in the setting of comorbid mood disorders and/or anxiety; little evidence to support the use of trazadone as drug of choice within this class*. |
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