Pediatric Sleep Disorders Medication
- Author: Dennis A Nutter Jr, MD; Chief Editor: Caroly Pataki, MD more...
Medication Summary
The goals of pharmacotherapy are to improve sleep maintenance and treat nocturnal enuresis. Many of the medications described below are not approved by the US Food and Drug Administration (FDA) for adolescents and children.
Vasopressin-Related
Class Summary
Desmopressin is a synthetic antidiuretic hormone with actions mimicking vasopressin. It is used for treating enuresis.
Desmopressin (DDAVP)
Desmopressin is used to treat primary nocturnal enuresis in children older than 6 years. It increases the cellular permeability of the collecting ducts, resulting in reabsorption of water by the kidneys.
Dopamine Agonists
Class Summary
Preliminary efficacious results for treatment using these agents have been noted in youths with restless legs syndrome (RLS) and periodic limb movement during sleep (PLMS). Findings are based on nonrandomized non–placebo-controlled study.
Pergolide was withdrawn from the US market on March 29, 2007, because of heart valve damage resulting in cardiac valve regurgitation. Do not abruptly stop pergolide. Health care professionals should assess patients’ need for dopamine agonist therapy and consider alternative treatment. If continued treatment with a dopamine agonist is needed, another such agent should be substituted for pergolide. For more information, see FDA MedWatch Product Safety Alert and Medscape Alerts: Pergolide Withdrawn From US Market.
Pergolide (Permax)
Withdrawn from US market. Pergolide is not FDA-approved for RLS or PLMS. It is a potent and long-acting dopamine agonist that reduces tonic stimulation of dopaminergic D2 receptors located on intrastriatal cholinergic neurons.
Antidepressants, TCAs
Class Summary
Tricyclic antidepressants are used for treating narcolepsy and enuresis. Scant data exist to support their use in childhood narcolepsy. Sudden death has been reported in 8 children, possibly related to use of imipramine and desipramine; findings have been inconclusive about the causes of these deaths. No FDA indication exists for use of these agents in children with narcolepsy and enuresis.
Imipramine (Tofranil, Tofranil PM)
Imipramine inhibits the reuptake of norepinephrine or serotonin (5-hydroxytryptamine, 5-HT) at the presynaptic neuron. It may be useful for treating pediatric attention deficit hyperactivity disorder (ADHD), as well as enuresis and, possibly, pediatric-onset narcolepsy.
Anticonvulsants
Class Summary
Valproic acid was efficacious in small case series for adults with RLS and PLMS.
Valproic acid (Depakene, Depakote, Stavzor)
It is likely that all forms of valproic acid have similar efficacy. The following preparations can be used: 250-mg tablet, 125-mg sprinkle capsule, or 250 mg/5 mL liquid (US preparations).
Metabolic & Endocrine, Other
Class Summary
Hormones are used for treating circadian rhythm disturbances.
Melatonin
Used to treat circadian rhythm disturbances in blind patients without light perception.
Nonbenzodiazepine Hypnotics
Class Summary
Studies of the use of sedative-hypnotics to treat sleep disorders are limited to adults, and no FDA indications are approved for children younger than 18 years.
Eszopiclone (Lunesta)
Eszopiclone is a nonbenzodiazepine hypnotic pyrrolopyrazine derivative of the cyclopyrrolone class. The precise mechanism of action is unknown but is believed to involve interaction with gamma-aminobutyric acid (GABA) receptors at binding domains close to, or allosterically coupled to, benzodiazepine receptors.
Eszopiclone is indicated for treatment of insomnia in adults by decreasing sleep latency and improving sleep maintenance. It has a short half-life (6 hours). Higher doses (ie, 2 mg for elderly and 3 mg for nonelderly adults) are more effective for sleep maintenance, whereas lower doses (ie, 1 mg for elderly and 2 mg for nonelderly adults) are suitable for treating difficulty in falling asleep.
Ramelteon (Rozerem)
Ramelteon is a melatonin receptor agonist with high selectivity for human melatonin MT1 and MT2 receptors. MT1 and MT2 are thought to promote sleep and to be involved in maintaining circadian rhythm and normal sleep-wake cycles. Ramelteon is indicated for insomnia in adults characterized by difficulty with sleep onset.
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[Best Evidence] Blumer JL, Findling RL, Shih WJ, Soubrane C, Reed MD. Controlled clinical trial of zolpidem for the treatment of insomnia associated with attention-deficit/ hyperactivity disorder in children 6 to 17 years of age. Pediatrics. May 2009;123(5):e770-6. [Medline].
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