# Insomnia (short-term management) - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - 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 - Verified date: 2026-08 ## 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 ## Treatment metadata - Zolpidem — 10 mg — oral.solid - Eszopiclone — 2 mg — oral.solid - Melatonin — 2 mg — oral.solid - Trazodone — 50 mg — oral.solid ## Complete treatment card ```text INSOMNIA (SHORT-TERM MANAGEMENT) 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 against 6 sources listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (4) - Trouble falling asleep, staying asleep, waking too early, or not getting back to sleep are the core complaints - These sleep complaints occur even though the person had an adequate chance to sleep - Daytime effects include lower productivity, low energy, frequent napping and difficulty concentrating [fatigue · poor concentration] - Insomnia may independently contribute to major depression, often accompanied by low mood and loss of interest [insomnia · loss of interest · low mood] TESTS (5) - Diagnosis is made clinically from a detailed sleep history; a 2- to 4-week sleep diary helps identify patterns - The Insomnia Severity Index uses 7 questions scored 0 to 4, for a maximum of 28, with over 14 flagging clinically significant insomnia - The Pittsburgh Sleep Quality Index covers 19 items across sleep quality, latency and duration over a one-month period - Actigraphy can't tell REM from non-REM sleep; polysomnography is needed for that distinction - Polysomnography is the gold standard for sleep disorders generally but isn't used routinely just to diagnose insomnia IF NOT THIS - what else fits (4) - Substance or medication use should be ruled out as a cause before diagnosing short-term insomnia - Obstructive or central sleep apnoea and restless legs syndrome need to be excluded - Circadian disorders such as delayed sleep phase, and shift-work sleep disorder, are also considered - Narcolepsy, sleepwalking or night terrors, and depression or anxiety disorders are also weighed Source StatPearls "Short-Term Insomnia" - disease-level clinical article Status traced to the source above Rx: Main treatment | Melatonin - over 55 or patient preference | If dependency risk MAIN TREATMENT - choose one 1. ZOLPIDEM [1st line] Adult 10 mg immediately before bedtime (5 mg in elderly or hepatic impairment); max duration 2-4 weeks x 1-2 weeks (max 4 weeks) Peds Contraindicated in children and adolescents under 18 years Choice Alternatives, both Z-drugs. Zolpidem is the more widely stocked and the better studied for short-term use. Source Zolpidem Tartrate 10 mg Tablets SmPC sections 4.2 and 4.4 (eMC product 3975) Why 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. Caution 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. Egypt ZODIUM 10MG 10 F.C. TAB. HIKMA PHARMA ... 12.60 EGP (1.26/unit) 2. ESZOPICLONE [1st line] Adult 1-2 mg immediately before bedtime (1 mg in elderly/hepatic impairment); max 3 mg nightly x 1-2 weeks (max 4 weeks) Peds Safety not established in pediatric populations 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." Why 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. Caution Avoid concurrent use with alcohol or potent CYP3A4 inhibitors. Unpleasant metallic dysgeusia (bitter taste) is very common. Next-day psychomotor impairment can occur. Egypt SLEEPOCLONE 2 MG 10 F.C. TABS. ALFACURE PHAR... 7.00 EGP (0.70/unit) NOCTIPLON 2 MG 20 F.C.TABS. EGPI > ABBOTT... 18.00 EGP (0.90/unit) MAGICPICLONE 2 MG 20 F.C.TABS. MEDIZEN PHARM... 27.00 EGP (1.35/unit) NESTACORAN 2 MG 20 F.C.TABS. HI-PHARM 40.00 EGP (2.00/unit) NIGHT CALM 2 MG 30 F.C.TABS. MEDIZEN PHARM... 60.00 EGP (2.00/unit) SLEEPEZ 2 MG 20 F.C.TABS. CHEMIPHARM 40.00 EGP (2.00/unit) SNOOZIPAX 2 MG 20 F.C. TABS. EVA PHARMA 43.00 EGP (2.15/unit) MELATONIN - OVER 55 OR PATIENT PREFERENCE 3. MELATONIN [2nd line] Adult 2 mg prolonged-release once daily, taken 1-2 hours before bedtime and after food - Up to 13 weeks Peds 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. Source eMC SmPC, Circadin 2 mg prolonged-release tablets (Flynn Pharma), sections 4.1 and 4.2 Why 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. Caution 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. Egypt MELATONIN 3 MG 20 CAPS. > HELIAN 60.00 EGP (3.00/unit) -> ? strength differs SLEPTONIN 5 MG 30 TABS. > BIOVITA PHA... 90.00 EGP (3.00/unit) -> ? strength differs AXIOM MELATONIN 1 MG 30 TABS. > AXIOM 120.00 EGP (4.00/unit) -> ? strength differs DOZOVA MELATONIN 5 MG 30 CAPS. ZETA PHARMA 149.00 EGP (4.97/unit) -> ? strength differs VEE MELATONIN 5 MG 30 TABS. VEEXIA PHARMA... 195.00 EGP (6.50/unit) -> ? strength differs MELADODO 3 MG 30 TABS. MASENZ DANYA ... 269.90 EGP (9.00/unit) -> ? strength differs MYVI SLEEP 60 PIECES ECC NUTRITION... 340.00 EGP [? strength differs] MELATONIN 3 MG 60 VEG. CAPS. (NOW) NOW FOODS > SOFICOPHARM 500.00 EGP -> ? strength differs MELASNOZ 1MG/ML SYRUP 60 ML ORGANIX > PHA... 60.00 EGP -> ? strength differs, ? different route - not oral solid MELATONIN 30 ML ORAL DROPS ORGANIX > EVO... 78.00 EGP -> ? strength differs, ? different route - not oral solid IF DEPENDENCY RISK 4. TRAZODONE [2nd line] Adult 25-50 mg at bedtime, may increase to 100 mg at bedtime if needed x 2-4 weeks Peds Not recommended in children for insomnia 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. Why Sedating antidepressant alternative preferred when substance dependency risk is present Caution 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. Egypt TRITTICO 50 MG 20 TABS. EIPICO > ANGLINY 38.00 EGP (1.90/unit) Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)