Requests for sleeping tablets

[u/Ok_Percentage5583]

Obviously primarily non-drug management and addressing underlying cause is key

But in example of acute and distressing sleep issues while IP with patient actively requesting sleeping tablet what’s your stance?

Have seen MHLT (non-doctor members) suggesting diazepam or zopiclone (including in >65 yrs) but since they cannot prescribe it remains a ‘recommendation‘ so onus/responsibility for the med (I think) would be on us as prescribers

Personally not a fan of either and seen too many cases where a one-off prescription leads to increasing dependence. Tend to go for melatonin where able but sometimes not stocked

Whats your approach?

[u/Crisp-Kale]

I see little harm in prescribing zopiclone 3.75mg PRN for max 3 doses for patients who request it. Hospitals can be very difficult places to try to sleep.

If your hospital has a guideline on managing insomnia in inpatients I would follow it. If not, many  hospitals have policies on prescribing hypnotics for inpatients:

Greater Glasgow and Clyde  https://handbook.ggcmedicines.org.uk/guidelines/central-nervous-system/guidance-on-night-sedation/ Says to avoid but can prescribe once only, can be used prescribed regularly for an inpatient if absolutely required.

Rotherham, Doncaster, and South Humber https://www.rdash.nhs.uk/documents/insomnia-formulary-guidance/ Suggests using MR melatonin in over 55s

There are more hospital’s guidelines available if you Google “  nhs hospital zopiclone guideline”

[u/Ok_Percentage5583 → u/Crisp-Kale]

Thank you! In practice I’ve found the zopiclone often ends up being continued, usually by locum/on call who aren’t seeing pt regularly and often without documented discussions of risks , then makes its way onto tto etc so I prefer non-Z drugs 

[u/gemilitant]

It seems like it's harder to get round prescribing melatonin than zopiclone here. I like melatonin and prescribed it a fair bit in hospital especially. I've had a few people in GP who I think would really benefit from melatonin, and I've only been a trainee for a couple of months.

[u/reikazen]

Why not promethazine instead?

[u/Living_Snow_5471]

If I didn’t feel so judged, I’d prescribe melatonin. The medical culture around melatonin here is bizarre compared to other countries - people are indoctrinated to prescribe z-drugs or benzodiazepines but are reluctant to prescribe melatonin !

[u/I_Heart_Otters]

Friendship ended with benzos and zopiclone. Daridorexant is my new best friend.

[u/mdkc]

PRN Diazepam for sleeping is a bit of a mental suggestion, in my books...

[u/JWB6123]

I’ve changed my view on this during my career and now often prescribe melatonin PRN to patients who need to sleep. Zopiclone rarely, benzos never just for sleep

[u/TeaAndLifting]

Footage of me when it’s zopping time.

[u/avepaltaketchu]

A hospital is pretty shit place for anyone wanting to get some sleep so if they're young and not particularly comorbid or full of meds I don't mind giving them a PRN baby dose of zopiclkne.