Lunivexa

Adults 18+ · Insomnia medication list · Inquiry only, no prices

Thirteen sleep medicines, every dose read off the US label.

This is the insomnia medication list the desk works from: prescription sleep medication for adults in four families, plus the over-the-counter shelf. Each agent gets a card with its indication, the label start dose, when to take it, whether it is controlled, and the safety lines people skip. Off-label use is stamped and gets no dose.

No cartNo price quotedPharmacy cost varies by plan

Suvorexant vs zolpidem

Two ways to get to sleep, side by side.

The question we get more than any other. One blocks the wake signal, the other turns up GABA and sedates. Neither is "stronger" in any useful sense. The difference that matters at 7 a.m. is how long each stays in the blood and which boxed warning sits on the label. Every figure below comes from the current prescribing information.

Source · FDA labels, Belsomra and Ambien prescribing information, sections 2, 5 and 12
LineSuvorexantZolpidem IRSource
How it worksBlocks orexin A and B receptorsGABA-A receptor modulatorSec 12.1
Start dose10 mg5 mg women · 5 or 10 mg menSec 2.1
Label maximum20 mg10 mgSec 2.1
Hours left in bedat least 7 h7 to 8 hSec 2.1
Half-lifeabout 12 habout 2.5 hSec 12.3
Boxed warningNoneComplex sleep behavioursBoxed / Sec 5.1
DEA scheduleIVIVSec 9.1

01 / 05 · Family

Orexin receptor antagonists

Schedule IVSleep onset and maintenance

Suvorexant, lemborexant and daridorexant. Orexin is the chemical that holds you awake; these block its receptors instead of sedating the whole brain. All three are taken close to bed with at least seven hours left. All three are contraindicated in narcolepsy, because narcolepsy is a loss of orexin to begin with. The common complaint is next-day sleepiness at the higher dose, not a hangover in the Z-drug sense.

Price basis · Inquiry only. No price quoted; pharmacy cost varies by plan and pharmacy.

One white tablet beside a glass of water on a dark slate surface at night

Suvorexant

Schedule IV

The first of the class, approved in 2014. Its half-life of roughly 12 hours is why the label keeps the ceiling at 20 mg and warns about driving the next day at that dose.

Indication
Insomnia: trouble falling or staying asleep
Label start dose
10 mg
Timing
Within 30 min of bed, at least 7 h left
Maximum
20 mg once nightly
  1. Not for narcolepsy. Sleep paralysis and dream-like hallucinations at sleep onset are listed reactions.
  2. Strong CYP3A inhibitors such as clarithromycin or ketoconazole: not recommended. Moderate inhibitors: 5 mg.
  3. Taking it with or soon after a meal delays the effect.
  4. At 20 mg, next-day driving was impaired in label studies. Start at 10.

Source · FDA label · Section 2 Dosage · Section 5.1

Lemborexant

Schedule IV

Taken immediately before bed rather than within a half-hour window. Half-life sits around 17 to 19 hours, the longest of the three, so the morning after is the part to watch.

Indication
Insomnia: onset and maintenance
Label start dose
5 mg
Timing
Immediately before bed, at least 7 h left
Maximum
10 mg once nightly
  1. Lemborexant side effects most often reported: somnolence, headache and nightmares or abnormal dreams.
  2. Somnolence ran near 10% at 10 mg in trials. Next-morning impairment is dose-related.
  3. Avoid with strong or moderate CYP3A inhibitors. With weak inhibitors, stay at 5 mg.
  4. Moderate liver impairment: 5 mg ceiling. Severe: not recommended.

Source · FDA label · Section 2 Dosage · Section 6 Adverse reactions

Daridorexant

Schedule IV

The shortest half-life in the family, about 8 hours. People ask for the daridorexant dosage because the label range starts at 25 mg, which looks high next to the others. The milligrams do not compare across drugs.

Indication
Insomnia: onset and maintenance
Label dose
25 to 50 mg
Timing
Within 30 min of bed, at least 7 h left
Maximum
50 mg once nightly
  1. Moderate liver impairment: 25 mg maximum. Severe: not recommended.
  2. Headache and somnolence were the most common reactions in trials.
  3. A high-fat meal pushes back the time to peak. Take it on a light stomach.

Source · FDA label · Section 2 Dosage · Section 12.3

Want the printable orexin card, or a side-by-side of daridorexant and lemborexant for your next appointment? Tell us which one and why.

Ask the desk

02 / 05 · Family

Z-drugs

Schedule IVBoxed warning

Zolpidem, eszopiclone and zaleplon. Fast onset, often inside 30 minutes. Since 2019 all three carry a boxed warning for complex sleep behaviours: sleepwalking, sleep-driving, cooking or leaving the house without being fully awake, some ending in serious injury or death. If it has happened to you once, the label says do not take any of the three again.

The failure we see most: a tablet at 2 a.m. with four hours left before the alarm, then the drive to work. Zolpidem IR needs 7 to 8 hours. Only zaleplon and low-dose sublingual zolpidem are labelled for a 4-hour window.

Price basis · Inquiry only. No price quoted; pharmacy cost varies by plan and pharmacy.

A partly used blister pack of sleep tablets on a white pharmacy bag

Zolpidem

Schedule IV

Zolpidem dosage for women is 5 mg. The FDA cut it from 10 mg in 2013 because women clear the drug more slowly and next-morning blood levels were high enough to impair driving. Men start at 5 or 10 mg.

Indication
Short-term insomnia with trouble falling asleep
Label start dose
5 mg women
Timing
Immediately before bed, 7 to 8 h left
Other forms
ER 6.25 mg women · SL 1.75 mg women, 4 h left
  1. Maximum 10 mg IR. Over-65s and people with liver impairment: 5 mg.
  2. Not with or right after a meal. Onset slows.
  3. No alcohol that night. Not with other sedatives at bedtime.
  4. Any sleepwalking or sleep-driving episode: stop and call the prescriber.
  5. ER tablets are swallowed whole. Never split or chewed.

Source · FDA label · Boxed warning · Section 2 Dosage

Eszopiclone

Schedule IV

Longer acting than zolpidem, half-life about 6 hours. The start dose dropped to 1 mg in 2014 after studies found 3 mg impaired next-morning driving and memory in some people who felt fine.

Indication
Insomnia: onset and maintenance
Label start dose
1 mg
Timing
Immediately before bed, 7 to 8 h left
Maximum
3 mg · 2 mg if over 65
  1. A bitter, metallic taste is the most reported side effect.
  2. A heavy or high-fat meal slows absorption.
  3. Strong CYP3A4 inhibitors: do not exceed 2 mg.
  4. Same boxed warning as zolpidem. Same rule after one episode.

Source · FDA label · Section 2 Dosage · Section 5.2

Zaleplon

Schedule IV

Half-life about one hour. That short tail is the reason it can be taken after lights out if sleep will not come, as long as four hours remain. It does little for waking at 4 a.m.

Indication
Short-term insomnia with trouble falling asleep
Label dose
10 mg
Timing
At bedtime, or later in bed with at least 4 h left
Range
5 mg older or low-weight adults · max 20 mg
  1. Four hours is the floor. Three and a half is not four.
  2. Cimetidine raises levels: 5 mg start.
  3. A heavy meal delays onset by about two hours.

Source · FDA label · Section 2 Dosage · Section 7 Interactions

Switching from zolpidem 10 mg to 5 mg, or asking whether a 4-hour dose fits your shift? Write in with the tablet strength on your bottle.

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03 / 05 · Family

Melatonin-receptor agonist

Not controlledSleep onset only

One agent. Ramelteon acts on the MT1 and MT2 receptors that melatonin uses, but it is a prescription drug with a fixed, tested dose, which melatonin from a shelf is not. Ramelteon is not a controlled substance. That is the main reason people ask about it: no DEA schedule, no dependence signal in the label studies. It helps people who cannot fall asleep. It does little for waking at 3 a.m.

Price basis · Inquiry only. No price quoted; pharmacy cost varies by plan and pharmacy.

A small prescription bottle beside a dimmed bedside lamp and a closed book

Ramelteon

Not controlled

Ramelteon, how to take it: 8 mg, within 30 minutes of going to bed, on a stomach that has not just had a fatty dinner. A high-fat meal raises exposure and delays the peak by roughly 45 minutes, which is the opposite of what a sleep-onset drug is for. Half-life is short, 1 to 2.6 hours.

Indication
Insomnia with difficulty falling asleep
Label dose
8 mg
Timing
Within 30 min of bed
Maximum
8 mg. There is no higher label dose.
  1. Never with fluvoxamine. That combination raises ramelteon levels many times over and is contraindicated.
  2. Not recommended in severe liver impairment.
  3. Complex sleep behaviours are listed as a warning, though not a boxed one.
  4. Can affect reproductive hormones. Missed periods or low libido belong in the prescriber conversation.
  5. Give it about 7 to 10 nights before judging it. A single night tells you little.

Source · FDA label · Section 2 Dosage · Section 4 Contraindications

Who asks about it

Desk notes

Most letters come from people who had a bad night on a Z-drug and want nothing with a boxed warning, or whose prescriber wants to avoid a scheduled drug after a history of substance use. Then there are shift workers, who usually learn from us that ramelteon is labelled for insomnia, not for resetting a body clock after nights.

Onset problem
Fits the label
Early waking
Not what it treats
Shift work
Not a label indication
Schedule
None

Source · FDA label · Section 1 Indications · desk inquiry log

Asking whether ramelteon would clash with something you already take? List every medicine and supplement, with strengths.

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04 / 05 · Family

Low-dose sedating antidepressants

Not controlledTwo of three off-label

Doxepin at 3 or 6 mg has a US label for sleep maintenance. Trazodone and mirtazapine do not. Both are antidepressants prescribed at low doses for sleep all the time, which is legal and common, but it is off-label, and the card says so in red. There is no label dose for sleep because there is not one. We will not print a number that no label supports.

Price basis · Inquiry only. No price quoted; pharmacy cost varies by plan and pharmacy.

A scored tablet split in half inside a pill cutter on a kitchen counter

Doxepin 3–6 mg

Label for sleep

Low dose doxepin for sleep is a different product from the 10 to 150 mg capsules used for depression. At 6 mg it works mainly on histamine receptors and helps people who wake in the night and cannot get back down.

Indication
Insomnia with difficulty staying asleep
Label dose
6 mg · 3 mg if 65+
Timing
Within 30 min of bed, not within 3 h of a meal
Maximum
6 mg once nightly
  1. Contraindicated with an MAO inhibitor taken in the past two weeks.
  2. Contraindicated with untreated narrow-angle glaucoma or severe urinary retention.
  3. Half-life around 15 hours. Morning drowsiness is possible.
  4. The 2023 Beers criteria accept doxepin up to 6 mg in older adults. Above that, avoid.

Source · FDA label · Section 2 Dosage · Section 4 Contraindications

Trazodone

Off-label

Trazodone for insomnia is off-label. Its US label covers major depressive disorder only. Prescribers use low doses at bedtime because it sedates and is not scheduled. The label gives no sleep dose, so neither do we.

Label indication
Major depressive disorder
Sleep dose
None on label
Schedule
Not controlled
Boxed warning
Suicidal thoughts under 25
  1. Priapism: an erection lasting over 4 hours is an emergency.
  2. Dizziness on standing. Get up slowly at night, especially over 65.
  3. QT prolongation is listed. Tell the prescriber about heart rhythm history.
  4. Serotonin syndrome risk rises with other serotonergic drugs.

Source · FDA label · Section 1 Indications · Section 5 · Off-label: no label dose

Mirtazapine

Off-label

Labelled for major depressive disorder. Used at bedtime when depression and poor sleep arrive together. Weight gain and increased appetite are the objections we hear most.

Label indication
Major depressive disorder
Sleep dose
None on label
Schedule
Not controlled
Boxed warning
Suicidal thoughts under 25
  1. Increased appetite and weight gain are common in the label trials.
  2. Rare low white cell count. Fever or sore throat means a call to the prescriber.
  3. Additive sedation with alcohol and benzodiazepines.

Source · FDA label · Section 1 Indications · Section 5 · Off-label: no label dose

Prescribed trazodone for sleep and want to know what the label does and does not cover? We send the card and a question sheet for your prescriber.

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05 / 05 · Family

Over-the-counter sleep aids

OTCNo prescription needed

Diphenhydramine, doxylamine and melatonin. The first two are old antihistamines. They are anticholinergic, which means dry mouth, constipation, trouble passing urine and, in older adults, confusion and falls. Diphenhydramine is on the Beers list for over-65s. It is the ingredient in most "PM" boxes. Melatonin is sold in the US as a dietary supplement, not an FDA-approved drug.

Price basis · Inquiry only. No price quoted; shelf price varies by store.

A person reading the drug facts panel on the back of an over-the-counter sleep aid box

Diphenhydramine

OTC

Diphenhydramine sleep aid risks in older adults are the reason this card exists. Tolerance to the sleepy effect builds within days. The anticholinergic load does not fade with it.

Drug Facts use
Relief of occasional sleeplessness
Box dose
50 mg at bedtime
Age
Box says 12+. Our card is adults only.
Stop and ask
If sleeplessness lasts over 2 weeks
  1. 2023 Beers criteria: avoid in adults 65 and over.
  2. Check your cold and allergy products. Many contain diphenhydramine already.
  3. Enlarged prostate or glaucoma: ask a pharmacist first.
  4. Next-morning grogginess is common and is a driving problem.

Source · OTC Drug Facts panel · AGS Beers Criteria 2023

Doxylamine

OTC

Same drawer, same problems. Doxylamine has a longer half-life than diphenhydramine, around 10 hours, so the morning fog can be heavier.

Drug Facts use
Nighttime sleep aid
Box dose
25 mg
Timing
30 min before bed
Stop and ask
If sleeplessness lasts over 2 weeks
  1. Anticholinergic. The same Beers caution applies over 65.
  2. No alcohol. No stacking with a second sleep product.
  3. Breathing problems such as emphysema: ask first, per the box.

Source · OTC Drug Facts panel

Melatonin

Supplement

There is no FDA-approved melatonin dose for adults, because melatonin is not an FDA-approved drug in the US. What is in the bottle varies. A 2017 analysis of 31 products found actual content from 83% below to 478% above the stated amount.

Status
Dietary supplement
Label dose
None approved
Panel
Supplement Facts, not Drug Facts
Schedule
Not controlled
  1. Higher is not better. Bottles run from 1 mg to 10 mg and beyond.
  2. A USP Verified mark means the contents were tested against the label.
  3. Can interact with blood thinners and some seizure medicines. Tell your pharmacist.
  4. Gummies are the easiest to over-take, for adults and for children in the house.

Source · FDA dietary supplement status · J Clin Sleep Med 2017 · no label dose

Over 65 and using a PM product most nights? Send us the active ingredient from the back of the box and we will send the card.

Ask the desk

After you write

A question in, a card and a question sheet out.

  1. 01

    You name the medicine

    Use the form below or the contact page. Give the drug, the strength on the bottle and your question. No diagnosis needed, no records.

  2. 02

    We check the current label

    Every figure is re-read against the current FDA label on DailyMed before the card goes out. If the label changed since the card was written, the card changes first.

  3. 03

    The card arrives by email

    A printable card for the family you asked about, and a one-page sheet of questions for your prescriber. The method behind both is on the about page.

  4. 04

    You take it to your prescriber

    Any change to a dose is theirs to make. We do not call your doctor, and we do not answer "should I" questions.

Before you ask

What people want to know first.

Can you get me a prescription?

No. We do not prescribe, dispense, sell or ship medicine, and we do not refer to anyone who will. We write the card and answer the question. For a prescription you need your own clinician.

Why no prices?

Because we do not sell anything, and because what you pay depends on your insurance plan, your pharmacy and whether a generic exists. A number from us would be wrong for most readers. Your pharmacist can quote a real figure in a minute.

Which one is best for me?

We will not answer that, and anyone online who does has not met you. What we do answer: what each label says, how the families differ, and which questions separate them. Bring those to the appointment.

Is this for teenagers?

No. Every card is written for adults 18 and over. We decline questions about anyone younger, including from parents. A pediatrician or pharmacist is the right call.

What if a card is wrong?

Tell us. We correct it and notify everyone who received that version. The window and the process are set out in the card accuracy guarantee.

Where are the benzodiazepines?

Not on this list yet. Temazepam and triazolam have insomnia labels, and we answer questions about them by email, but the printed cards cover the five families above. Read the safety rules first either way; the opioid and alcohol rules apply with more force to benzodiazepines.

Inquiry desk · Austin, Texas

Name the card you want.

One family per message works best. Include the strength printed on your bottle. Reply by email, usually with the card attached.

Information only. Not a prescription, not a diagnosis. Talk to your prescriber or pharmacist before starting, stopping or changing a dose.

Copy it from the bottle, for example zolpidem 5 mg.