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Dr. Andrew Rynne

Family Physician

Exp 50 years

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I have been taking zolpidem tartrate 5 mg. for years.

Answered by
Dr. Aaron Branch

General & Family Physician

Practicing since :2011

Answered : 380 Questions

Posted on Thu, 31 Jan 2019 in Mental Health
Question: I have been taking zolpidem tartrate 5 mg. for years. I recently changed insurance companies and even though it's on their formulary they say I need prior authorization. They suggested Trazodone or belsomra. I have lupus, hashimoto's disease, kidney disease, fatty liver and I am disabled due to chronic depression. I long ago attempted suicide but that was 25 years ago. What are other sleep medications I might be able to take?
Answered by Dr. Aaron Branch 57 minutes later
Brief Answer:
Benzodiazepines can be tried

Detailed Answer:
Hello, I'm Dr. Branch, thanks for using Ask a Doctor.

For insomnia, besides the behavioral therapy such as maintaining a regular sleep schedule, avoiding caffeine after lunch, avoiding alcohol at bedtime, getting regular exercise and avoiding daytime naps, there are many other medications that can be used as well. One option is benzodiazepines such as temazapam or triazolam. If you have not used melatonin, this is a good option, or ramelteon, which is similar to melatonin. Orexin receptor antagonists are new medications for insomnia which include suvorexant (but these medications will not likely be covered by insurance).

Other possibilities are other antidepressants other than trazodone, such as doxepin. Sometimes the antihistamine diphenhydramine or antipsychotics such as amitriptyline are also used, but they are not recommended and evidence hasn't shown consistent benefit.

My recommendations would be to look at benzodiazepines such as temazapam or ramelteon if you have not already. Otherwise, you may need to try the medications your insurance suggests first before you get approval for zolpidem, depending on how your insurance works.

I hope that helps and gives you some things to discuss with your doctor. Please let me know if you have any other questions about that and I would be glad to discuss it further with you.
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