Mirtazapine Alternative - Insomnia

[Tesco Clubard]

I have been taking Mirtazapine for about a year now to help combat insomnia, the sedative effect of the drug is helpful. I have read that it is the stongest H1 receptor antagonist on the market. (it is strange that when a drug sedates you too much you get a paradoxical effect as you fight to stay upright!) Unfortunately the drug has a long half life so causes me to be too sedated during the day. Is there another drug with a similarly potent sedating effect with a substantially shorter half life that I will not develop a quick tolerance to? Thanks

[johnep]

Mirtazapine is an anti-dpressant. In depression, insomnia is a symptom. Often pt wakes up at 4am and worries about the world or whatever causing the depression (if there is an exogenous cause).

You should discuss this with your Dr.
johnep

[Shwampa]

Mirtazapine is one of the preferred drug when your doctor wants to help improve your sleep. Another alternative? off course there're, but first are you taking it for depression and what other medication you're on?

The TCA, mainly Amitriptyline, are sedating. Another one, which I'm not sure is available in the UK is Trazodone, very popular in the states.

Quetiapine (Neuroleptic) is another good one.

[johnep]

You have very good knowledge. Trazadone (molipaxin) still used here and quetiapine (Serquel) very popular. We are having supply problems with seroquel as cos are restricting supplies to try to stop export to USA and continent as pound weak.

I do love these clinical discussions except when someone is dogmatic.
ie co-prox.
johnep

[Tesco Clubard]

Thanks for you replies, I know that Mirtazapine is an anti depressant, however my doctor has prescribed it for it's sedating effect, my insomnia is related to sleep onset, it is as if I am just a bit more highly strung than most people (I think it's called hyperarousal) and need a bit of help getting down to a level where sleep is more likely, it's as though I operate at a level just too far above the imaginary sleep line and need some sedation to get closer to it. I have tried taking only 15mg of Mirtazapine and even 7.5mg in an effort to reduce the daytime sedation, 7.5mg is right on the edge of not delivering enough night time sedation. One drug that I looked up was Promethazine, how does the potency of this in relation to H1 blockade compare to Mirtazapine and would I develop too quick a resistance to it?

I'm on no other medication, I have tried Respiridone recently but that made the insomnia worse.

Thanks

[Nik]

I was always under the impression that promethazine was prone to daytime sedation, more so than diphenhydramine. Hydroxyzine may be an alternative useful preparation.

[Tesco Clubard]

Thanks for your reply, according to Wikipedia Promethazine has a half life of 16-19 hours and Diphenhydramine is only 2-8 hours, it does say though that "Diphenhydramine has been shown to build tolerance against its sedation effectiveness very quickly, with placebo-like results after a 3rd day of common dosage." so not much use for me unfortunately. I read up about your suggestion of Hydroxyzine wich has a half life of 20-25 hours so is a bit better than Mirtazapine, whilst looking at piperazines I noticed Meclizine which has a half life of 6 hours that would be ideal, can you tell me whether this would be an appropriate drug in other respects such as sedative effect and resistance?

Thanks

[Nik]

Meclozine is the active ingredient of Sea Legs, used for motion sickness. It blocks histamine receptors in the area postrema in the brain, which controls nausea. It can cause drowsiness as a side effect but probably not enough to warrant its use primarily as a sedative.

[johnep]

Diphenhydramine (Benadryl) was one of the early antihistamines which is now used for it's drowsiness side effect.

Sleep architecture is a fascinating subject in its own right. For just difficulty in getting off to sleep, then Midazolam has shortest action. Me I would suggest perhaps diazepam 2 - 5 mgs taken 10-15 minutes before getting into bed. It is what I used to take when transatlantic flying. Otherwise, amitryptyline 10-25mg should ensure sleeping through the night with being able to get back to sleep after a mid night trip to the loo.

johnep

[bobbin]

I have been taking Mirtazapine for about a year now to help combat insomnia, the sedative effect of the drug is helpful. I have read that it is the stongest H1 receptor antagonist on the market. (it is strange that when a drug sedates you too much you get a paradoxical effect as you fight to stay upright!) Unfortunately the drug has a long half life so causes me to be too sedated during the day. Is there another drug with a similarly potent sedating effect with a substantially shorter half life that I will not develop a quick tolerance to? Thanks

Mirtazapine (Zispin, Remeron), a popular antidepressant, is indeed a very potent antihistamine with sleep-inducing properties. Unfortunately, all of the sedative antidepressants have a relatively long duration of action and will tend to cause daytime drowsiness. Mirtazapine is also notorious for causing weight gain, which can be very substantial.

Sedative antihistamines such as promethazine (Phenergan), sedative antipsychotics such as quetiapine (Seroquel) and sedative antidepressants such as amitriptyline, doxepin, dosulepin, trimipramine and trazodone all cause daytime drowsiness very frequently. Diphenhydramine (Nytol) is less problematic in this respect but rapid tolerance to its sedative effects is usual. Hydroxyzine is not generally very effective as a sleep aid. Meclizine doesn't usually cause much sedation.

Zolpidem (Stilnoct, Ambien) and zopiclone (Zimovane, Imovane) are reliably effective night sedatives which cause daytime drowsiness less commonly........but long-term use is not advisable. Either drug can be used intermittently in chronic insomnia or for a few days at a time during a crisis.

Temazepam is a safe and effective drug for short-term or occasional use but long-term use will lead to dependence.

Melatonin products are occasionally effective for chronic insomnia in the elderly. Melatonin is not normally effective in young adults. It is often prescribed for insomnia in children with behavioural problems but such use is not well proven.

Bobbin