Neubauer David N
Department of Psychiatry and Behavioral Science, Johns Hopkins University School of Medicine , Baltimore, Maryland , USA.
Int Rev Psychiatry. 2014 Apr;26(2):214-24. doi: 10.3109/09540261.2014.888990.
Advances in understanding the neurochemistry of sleep and waking have stimulated new pharmacological directions in the treatment of insomnia. While the sedation of historic insomnia medications was discovered serendipitously, now compounds can be developed for specific molecular targets with known sleep-related actions. Numerous investigational compounds, including some entirely novel approaches, are being evaluated currently as possible insomnia treatments. In recent years the US Federal Drug Administration (FDA) has approved medications with new pharmacodynamic and pharmacokinetic properties thereby extending the options for personalized pharmacotherapy. The FDA is reviewing new applications for innovative sleep-promoting medications currently, including suvorexant and tasimelteon. Presently the FDA-approved insomnia treatment medications include benzodiazepine receptor agonists available in immediate-release, extended-release, and alternative delivery oral absorption formulations; a melatonin receptor agonist; and a histamine receptor antagonist. Clinical indications include insomnia associated with difficulty with sleep onset, sleep maintenance, and middle-of-the-night awakenings. Alternative approaches to treating insomnia have included prescription medications employed on an off-label basis for insomnia, over-the-counter sleep aids, and assorted unregulated substances marketed to enhance sleep.
在理解睡眠和清醒的神经化学方面取得的进展激发了治疗失眠的新药理学方向。虽然历史上治疗失眠药物的镇静作用是偶然发现的，但现在可以针对具有已知睡眠相关作用的特定分子靶点开发化合物。目前正在评估许多研究性化合物，包括一些全新的方法，作为可能的失眠治疗方法。近年来，美国联邦药物管理局（FDA）已批准具有新药效学和药代动力学特性的药物，从而扩展了个性化药物治疗的选择。FDA目前正在审查创新促眠药物的新申请，包括苏沃雷生和他司美琼。目前FDA批准的失眠治疗药物包括速释、缓释和替代给药口服吸收制剂的苯二氮䓬受体激动剂；褪黑素受体激动剂；以及组胺受体拮抗剂。临床适应症包括与入睡困难、睡眠维持困难和半夜醒来相关的失眠。治疗失眠的替代方法包括用于失眠的非标签处方药、非处方睡眠辅助药物以及各种声称可改善睡眠的不受监管物质。
