Management of sleep disorders among children and adolescents with neurodevelopmental disorders: A practical guide for clinicians

Table 5 Showing drugs used to treat insomnia[17]

Pharmaceutical	Class	Mechanism of action	Half life (h)	Site of metabolism	Peak concentration	Interactions	Effect on sleep
Diphenhydramine	Antihistamine	H1 agonist. Crosses blood-brain barrier	4-6	Hepatic	Fast absorption. Fast onset of action. Peak at 2-4 h	CNS depressants	Reduces latency. May decrease quality
Hydroxyzine	Antihistamine	H1 agonist. Crosses blood-brain barrier	6-24	Hepatic	Fast absorption. Fast onset of action. Peak at 2-4 h	CNS depressants	Reduces latency. May decrease quality
Melatonin	Neuro-hormone	Hypnotic	90% excreted in 4	Hepatic	30-60 min	Unknown	Reduces latency. Maximum circadian effect
Clonazepam	Benzodiazepine	Central GABA receptors	30-40	CYP 450 3A oxidation	60-240 min	Fluoxetine	Suppresses slow-wave sleep. Reduces arousal
Flurazepam	Benzodiazepine	Central GABA receptors	2-100	CYP 450 3A oxidation	30 min to 13 h	Fluoxetine	Suppresses slow-wave sleep. Reduces arousal
Zolpidem	Z-drug	Benzodiazepine-like	2.5-3	CYP 450 3A oxidation	90 min		Reduces latency. Weak effect on sleep architecture
Clonidine	Alpha agonist	Inhibits noradrenaline release	6-24	50%-80% in urine	Fast absorption 100% bioavailability. Onset of action: 1 h. Peak effect: 2-4 h		Reduce REM. Reduces slow-wave sleep

REM: Rapid-eye-movement; CYP: Children and young people.