Pharmacy/sonata

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Question
hi,would like a little advive ftom you.you are more personal then the other experts/who always never answer the question the way you ask iti am 80 with diabetes,hypertension and a-fib.but these are all under  control and my bloodwork is always normal/all my bloodwork up.i take 15mg of sonata a few    times a week.the dodosing say elderly should take 5mg which is nonsense 5mg would not evev put my cat to sleep.the write up says you should not take sonata long term.who the hell has insomnia for 10 days.was thinking of rotating sonata with remeron but that drug has a list of side effects that go on forever.what say you.i took 15 mg remeron one week no problems

Answer
Hello Howard.
Both Sonata (Zaleplon) and Remeron (mirtazapine) have their own list of adverse events, precautions and interactions.  I would not say that one is less problematic than the other, or that one is better.  They are too different to be compared in that way.  Each one has its own risks and benefits.  Let's not forget that Sonata has issues with tolerance and dependence, which in turn, can lead to withdrawal symptoms if the drug is stopped abruptly.  And it is also associated with disturbed behavior, such as sleep walking etc.  I'm not listing these to alarm you, but merely to highlight that one drug is not 'cleaner' than the other.

The reason why Sonata is only recommended for short-term use is due to the risks associated with tolerance, dependence and withdrawal.  Clinical trials have only studied the drug in patients being treated between 1 night - 5 weeks in duration.  This is reflected in the FDA's approval of the drug for short-term treatment of up to 30 days.  This is the theory anyway, not just for Sonata but for other drugs within closely related drug classes.  In reality, however, there are patients who suffer from insomnia long-term and who may need longer treatment.  But even in the most severe of cases, it would be ethically inappropriate to prescribe such a drug without making serious attempts at uncovering the underlying cause of the insomnia and implementing other means for improving sleep hygiene.

I personally would not advise using Remeron for the mere purpose of inducing sleep.  Yes, it may cause drowsiness as a side effect, but this is not what the drug is indicated or approved for.  If a physician decided that depression was the main feature and that the patient might benefit from the sedative effects of Remeron, then the drug would seem clinically appropriate.  And as you pointed out, Remeron has side effects and other issues of its own.  By adding another drug to the regime, you will be experiencing side effects from both drugs.  Ideally, one drug should be optimized before adding another.  

I would suggest using Sonata only when absolutely necessary (rather than on a regular basis).  Be certain to adhere to good sleep hygiene behavior, which we discussed in a previous answer (avoid day-time naps, minimize caffeine, get exercise etc etc).  Try to make a serious attempt at falling asleep 'drug-free'.  Once your body becomes dependent on sleeping medications, it becomes increasingly difficult to fall asleep without them.  Rebound insomnia is a known effect of withdrawal.  You must soldier through this difficult period.  Your body will fall asleep when it needs it.

Good luck, Howard.  All the best.  

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Gisella Campanelli

Expertise

I am able to answer questions relating to pharmaceuticals, therapeutic regimes and primary health care. This includes offering advice on drug indications, dosages, and disease state management. I can also identify side effects, drug interactions and contra-indications, and offer recommendations on ways to mitigate these. I can diagnose minor illnesses and suggest appropriate over-the-counter remedies and/or preventive healthcare tips. I can recognize cardinal symptoms which would otherwise require referral to a medical practitioner.

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I am a registered pharmacist in Australia, and I have practiced in a hospital pharmacy for over thirteen years. My clinical specializations lie within the areas of psychiatry and general medicine (including gastroenterology, respiratory, endocrinology, neurology, infectious diseases, gerontology, dermatology). I self-managed the training program for pharmacy interns in preparation for their final registration exams, and I have worked for the Pharmacy Board of Australia as an examiner and exam writer.

Education/Credentials
I hold a Bachelor of Pharmacy from the Victorian College of Pharmacy, Monash University, and I am board-registered to practice within Australia. I also hold a Master's degree in an unrelated field (art conservation).

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