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To investigate effects on combination use of Ramelteon in the dose reduction or interruption process of (non-)BZD hypnotics during the dose reduction or interruption algorithm.
Full description
The hypnotic 'Ramelteon' does not have effect on Gamma Aminobutyric Acid (GABA-A) receptor that relates to the formation of addiction to the BZD or non-BZD hypnotics. Some results of clinical trials has been reported that the dose reduction or interruption of (non-)BZD hypnotics was achieved on combination use of Ramelteon by using its characteristic of the action mechanism with safely and effectively. However, these results have not been confirmed with randomized controlled trials.
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Inclusion criteria
Subjects meeting Criteria 1 or 2 and Criteria 3 and all subsequent criteria will be included in the study:
Patients diagnosed as chronic insomnia having sleep onset disturbance, and with a duration of the disease of at least 6 months
Patients diagnosed with chronic insomnia comorbid with mood disorders (depression or bipolar disorder) can be included to this study if they have remission of mood symptoms.
Patients taking (non-)BZD hypnotics (including etizolam at bedtime) at a fixed dose in the following patterns since at least 1 month prior to consent (over 90% of drug compliance should be confirmed at the time of medical interview):
Patients taking 2 drugs at the usual dose (1 unit)
Patients taking 3 drugs at the usual dose (1 unit)
Patients taking 4 drugs at the usual dose (1 unit)
Patients taking a drug at 2-fold of the usual dose (2 units)
Patients taking a drug at 2-fold of the usual dose (2 units) and a drug at the usual dose (1 unit)
Patients taking a drug at 2-fold of the usual dose (2 units) and 2 drugs at the usual dose (1 unit)
Patients taking 2 drugs at 2-fold of the usual dose (2 units) Patients whose total dosage are 2～4 units of 1～4 drugs can be also included. But attention needed not to conflict with exclusion criteria 2.
※Dosage cannot exceeded 2 units per 1 drug.
Patients whose symptoms of insomnia were stabilized, and the investigators determined that the (non-) BZD hypnotics could be reduced or discontinued
Patients aged 20 years or older at the time of consent
Patients who are willing to comply with algorithm for dose reduction and discontinuation
Patients who can understand the content of the study and provide consent to participate in the study in writing on their own will.
Exclusion criteria
Subjects meeting any of the following criteria will not be included in the study:
Patients with secondary insomnia
Patients taking (non-)BZD hypnotics at a dose exceeding 2-fold of the usual dose
Patients taking barbiturate and non-barbiturate hypnotics and Suvorexant.
Patients taking hypnotics other than medicinal pharmaceuticals (including Over The Counter (OTC), supplements believed to be effective for insomnia and melatonin )
Patients taking mianserin hydrochloride, mirtazapine, and trazodone hydrochloride
Patients taking antipsychotics
Patients taking anxiolytic or clonazepam at bedtime
*Patient taking anxiolytic and/or clonazepam at times except for bed-time will be included in the study. However, dosage and timing of administration can not be changed during the study period.
Patients who took ramelteon within 1 month prior to the informed consent
Patients in whom the dose of psychotropics except for the items 2～7 were changed within 1 month prior to the informed consent
Patients who are comorbid with depression or bipolar disordered and in whom depressive symptoms have not remitted
Patients in whom frequency in Q9 of PHQ "thoughts that you would be better off dead or thoughts of hurting yourself in some way" is "more than half the days (in the past 2 weeks)" or the total score is 10 or higher
Patients with dementia, schizophrenia, drug dependence and alcoholic
Patients with liver/kidney disorder, female subjects who are pregnant or in breast-feeding, and malignant neoplasm
Night workers
Patients meeting contraindications for ramelteon
Other patients judged ineligible for participation in the study by the investigator
Primary purpose
Allocation
Interventional model
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17 participants in 2 patient groups, including a placebo group
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Data sourced from clinicaltrials.gov
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