Indications for DORAL:
Use lowest effective dose. Initially 7.5mg at bedtime; may increase to 15mg if needed.
Sleep apnea. Pulmonary insufficiency.
Risks from concomitant use with opioids (see Interactions). Risk of CNS depressant effects and next-day impairment. Evaluate for co-morbid diagnoses before initiation. Reevaluate if insomnia fails to remit after 7–10 days of use. Depression. Suicidal tendencies. Abnormal thinking and behavioral changes. Drug or alcohol abuse. Write ℞ for smallest practical amount. Avoid prolonged use. Withdraw gradually. Elderly (higher risk of falls). Debilitated. Labor & delivery. Neonates. Pregnancy (Cat.C). Nursing mothers.
Increased sedation, respiratory depression, coma, and death with concomitant opioids; reserve use in those for whom alternative treatment options are inadequate; if needed, limit dosages/durations to minimum and monitor. Concomitant other sedative/hypnotics: not recommended. Additive CNS depressant effects with alcohol, other CNS depressants (eg, other benzodiazepines, TCAs, psychotropics, anticonvulsants, antihistamines); consider dose reductions.
Drowsiness, headache, fatigue, dizziness, dry mouth, dyspepsia; CNS effects, complex behaviors (eg, sleep-driving), anaphylaxis, angioedema.