{ "schema_version": 1, "kind": "condition", "id": "insomnia", "name": "Insomnia (short-term management)", "category": "chronic", "sources": "Lunivia 2 mg film-coated tablets (eszopiclone) SmPC section 4.2 (eMC product 100419): \"Adults: The recommended starting dose is 1 mg. The dose can be increased to 2 mg or 3 mg if clinically indicated. The lowest effective dose should be used. The total dose of eszopiclone should not exceed 3 mg.\" · NICE Guideline TA77 · AASM Clinical Practice Guideline 2017 · Zolpidem Tartrate 10 mg Tablets SmPC sections 4.2 and 4.4 (eMC product 3975) · Trazodone 100 mg capsules SmPC sections 4.2 and 4.4 (eMC product 4976) · Trazodone - StatPearls - NCBI Bookshelf (NBK470560), Indications and Administration · eMC SmPC, Circadin 2 mg prolonged-release tablets (Flynn Pharma), sections 4.1 and 4.2", "review_status": "reviewed", "verified_against": "Lunivia 2 mg film-coated tablets (eszopiclone) SmPC section 4.2 (eMC product 100419): \"Adults: The recommended starting dose is 1 mg. The dose can be increased to 2 mg or 3 mg if clinically indicated. The lowest effective dose should be used. The total dose of eszopiclone should not exceed 3 mg.\" · Zolpidem Tartrate 10 mg Tablets SmPC sections 4.2 and 4.4 (eMC product 3975) · AASM Clinical Practice Guideline 2017 · Trazodone 100 mg capsules SmPC sections 4.2 and 4.4 (eMC product 4976) · Trazodone - StatPearls - NCBI Bookshelf (NBK470560), Indications and Administration · eMC SmPC, Circadin 2 mg prolonged-release tablets (Flynn Pharma), sections 4.1 and 4.2", "verified_date": "2026-08", "treatments": [ { "id": 995, "generic": "Zolpidem", "line": 1, "is_adjunct": false, "form": "oral.solid", "strength_mg": 10.0, "adult_dose": "10 mg immediately before bedtime (5 mg in elderly or hepatic impairment); max duration 2-4 weeks", "adult_duration": "1-2 weeks (max 4 weeks)", "dose_source": "Zolpidem Tartrate 10 mg Tablets SmPC sections 4.2 and 4.4 (eMC product 3975)", "rationale": "Non-benzodiazepine sedative-hypnotic (Z-drug) that binds the GABA-A/benzodiazepine receptor complex to promote sleep onset. Reserved for insomnia rather than used indefinitely, given its potential for dependence, rebound insomnia, and complex sleep behaviors.", "cautions": [ "There is a risk of complex sleep behaviors (sleep-driving, sleep-eating, sleepwalking); discontinue immediately if observed.", "Next-day residual sedation and impairment of driving ability can occur.", "There is a high risk of tolerance, dependence, and rebound insomnia upon abrupt withdrawal.", "Avoid alcohol and concurrent CNS depressants.", "Four weeks is the outside limit, and the taper counts inside it - not four weeks then a wind-down.", "Sleepwalking, sleep-driving, eating and phoning with no memory of any of it are documented. If it happens once, stop the drug.", "No alcohol with it. Eight hours between the dose and driving, machinery, or working at height.", "Dependence can set in within weeks at an ordinary dose - it is not only a long-term-use problem.", "One dose, taken immediately at bedtime. Never a second one the same night." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Contraindicated in children and adolescents under 18 years", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "ZODIUM 10MG 10 F.C. TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "HIKMA PHARMA > FUTURE PHARMACEUTICAL INDUSTRIES (FPI)", "price_egp": 12.6, "pack_count": 10, "unit_price": 1.26, "strength_mg": 10.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "insomnia" }, { "id": 996, "generic": "Eszopiclone", "line": 1, "is_adjunct": false, "form": "oral.solid", "strength_mg": 2.0, "adult_dose": "1-2 mg immediately before bedtime (1 mg in elderly/hepatic impairment); max 3 mg nightly", "adult_duration": "1-2 weeks (max 4 weeks)", "dose_source": "Lunivia 2 mg film-coated tablets (eszopiclone) SmPC section 4.2 (eMC product 100419): \"Adults: The recommended starting dose is 1 mg. The dose can be increased to 2 mg or 3 mg if clinically indicated. The lowest effective dose should be used. The total dose of eszopiclone should not exceed 3 mg.\"", "rationale": "Non-benzodiazepine sedative-hypnotic (Z-drug) that also acts at the GABA-A receptor complex to promote both sleep onset and maintenance. An alternative first-line hypnotic to zolpidem per AASM guidance, most often distinguished in practice by its characteristic metallic aftertaste.", "cautions": [ "Avoid concurrent use with alcohol or potent CYP3A4 inhibitors.", "Unpleasant metallic dysgeusia (bitter taste) is very common.", "Next-day psychomotor impairment can occur." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Safety not established in pediatric populations", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "SLEEPOCLONE 2 MG 10 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ALFACURE PHARMACEUTICALS", "price_egp": 7.0, "pack_count": 10, "unit_price": 0.7, "strength_mg": 2.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "NOCTIPLON 2 MG 20 F.C.TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EGPI > ABBOTT LABORATORIES", "price_egp": 18.0, "pack_count": 20, "unit_price": 0.9, "strength_mg": 2.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "MAGICPICLONE 2 MG 20 F.C.TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MEDIZEN PHARMACEUTICAL INDUSTRIES > MAGIC PHARMA-EGYPT", "price_egp": 27.0, "pack_count": 20, "unit_price": 1.35, "strength_mg": 2.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "NESTACORAN 2 MG 20 F.C.TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "HI-PHARM", "price_egp": 40.0, "pack_count": 20, "unit_price": 2.0, "strength_mg": 2.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "NIGHT CALM 2 MG 30 F.C.TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MEDIZEN PHARMACEUTICAL INDUSTRIES", "price_egp": 60.0, "pack_count": 30, "unit_price": 2.0, "strength_mg": 2.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "SLEEPEZ 2 MG 20 F.C.TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "CHEMIPHARM", "price_egp": 40.0, "pack_count": 20, "unit_price": 2.0, "strength_mg": 2.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "SNOOZIPAX 2 MG 20 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EVA PHARMA", "price_egp": 43.0, "pack_count": 20, "unit_price": 2.15, "strength_mg": 2.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "insomnia" }, { "id": 997, "generic": "Melatonin", "line": 2, "is_adjunct": false, "form": "oral.solid", "strength_mg": 2.0, "adult_dose": "2 mg prolonged-release once daily, taken 1-2 hours before bedtime and after food", "adult_duration": "Up to 13 weeks", "dose_source": "eMC SmPC, Circadin 2 mg prolonged-release tablets (Flynn Pharma), sections 4.1 and 4.2", "rationale": "31 live products and the drug patients ask for as an alternative to a hypnotic. The licensed indication is short-term treatment of primary insomnia characterised by poor sleep quality in patients aged 55 or over, as monotherapy - a group where zolpidem and eszopiclone carry real fall and confusion risk.", "cautions": [ "The licence is for primary insomnia in patients aged 55 and over. Use below that age is off-label - common, but say so to the patient.", "Monotherapy only - the licence does not cover adding it to the zolpidem, eszopiclone or trazodone in this row.", "Much of what is sold in Egypt is an immediate-release supplement, not the licensed prolonged-release tablet. The two do not behave the same and are not interchangeable.", "Swallow the prolonged-release tablet whole - crushing destroys the release profile.", "Melatonin has a moderate effect on driving and machinery because of drowsiness.", "Not recommended in hepatic impairment (levels rise markedly) or in autoimmune disease (no data).", "Fluvoxamine raises melatonin levels roughly 17-fold - avoid the combination. Smoking lowers levels via CYP1A2 induction; alcohol abolishes the benefit." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Safety and efficacy in children aged 0 to 18 years have not been established for this product. Paediatric melatonin for sleep disorders in neurodevelopmental conditions is a specialist prescription with different products and doses.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "MELATONIN 3 MG 20 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "> HELIAN", "price_egp": 60.0, "pack_count": 20, "unit_price": 3.0, "strength_mg": 3.0, "exact_strength": false, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "SLEPTONIN 5 MG 30 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "> BIOVITA PHARMA GROUP", "price_egp": 90.0, "pack_count": 30, "unit_price": 3.0, "strength_mg": 5.0, "exact_strength": false, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "AXIOM MELATONIN 1 MG 30 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "> AXIOM", "price_egp": 120.0, "pack_count": 30, "unit_price": 4.0, "strength_mg": 1.0, "exact_strength": false, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "DOZOVA MELATONIN 5 MG 30 CAPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ZETA PHARMA", "price_egp": 149.0, "pack_count": 30, "unit_price": 4.97, "strength_mg": 5.0, "exact_strength": false, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "VEE MELATONIN 5 MG 30 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "VEEXIA PHARMACEUTICAL INDUSTRIES", "price_egp": 195.0, "pack_count": 30, "unit_price": 6.5, "strength_mg": 5.0, "exact_strength": false, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "MELADODO 3 MG 30 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MASENZ DANYA GROUP", "price_egp": 269.9, "pack_count": 30, "unit_price": 9.0, "strength_mg": 3.0, "exact_strength": false, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "MYVI SLEEP 60 PIECES", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ECC NUTRITION HUB > MYVI", "price_egp": 340.0, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": false, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "MELATONIN 3 MG 60 VEG. CAPS. (NOW)", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "NOW FOODS > SOFICOPHARM", "price_egp": 500.0, "pack_count": null, "unit_price": null, "strength_mg": 3.0, "exact_strength": false, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "MELASNOZ 1MG/ML SYRUP 60 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ORGANIX > PHARMA TECNOPROF", "price_egp": 60.0, "pack_count": null, "unit_price": null, "strength_mg": 1.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null }, { "trade_name": "MELATONIN 30 ML ORAL DROPS", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ORGANIX > EVOKA PHARMA", "price_egp": 78.0, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null } ], "condition_id": "insomnia" }, { "id": 998, "generic": "Trazodone", "line": 2, "is_adjunct": false, "form": "oral.solid", "strength_mg": 50.0, "adult_dose": "25-50 mg at bedtime, may increase to 100 mg at bedtime if needed", "adult_duration": "2-4 weeks", "dose_source": "Trazodone 100 mg capsules SmPC sections 4.2 and 4.4 (eMC product 4976) for the product, its cautions and its contraindications, with the insomnia dose from Trazodone - StatPearls - NCBI Bookshelf (NBK470560): \"Insomnia: Studies showed that administering 50 to 100 mg per day of trazodone helped nonorganic insomnia due to depressive disorder, with 100 mg dosage as the most effective to improve sleep.\" Neither document states a 25 mg dose - the SmPC carries no insomnia indication and its lowest figure is 75 mg a day.", "rationale": "Sedating antidepressant alternative preferred when substance dependency risk is present", "cautions": [ "There is a risk of priapism (painful prolonged erection requiring medical emergency intervention).", "Caution in cardiac disease and arrhythmias.", "The licence is for depression, starting at 150 mg a day. Using 25-100 mg for sleep is off-label - common and reasonable, but not what the label covers.", "Priapism, rarely. Tell men what it is and that an erection lasting hours is an emergency department visit that night, not a wait-and-see. Stop the drug immediately if it happens.", "Orthostatic hypotension and drowsiness can occur." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Not recommended in children for insomnia", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "TRITTICO 50 MG 20 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EIPICO > ANGLINY", "price_egp": 38.0, "pack_count": 20, "unit_price": 1.9, "strength_mg": 50.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "insomnia" } ] }