She adds, “Pharmacologic interventions can be pursued when nonpharmaceutical techniques are inadequate to relieve insomnia.”
The pharmacological options include:
Melatonin regulates the circadian rhythm, lowers core body temperature and reduces inflammatory markers associated with atopic dermatitis, such as IL-4 and immunoglobulin E.
Sedating antihistamines, such as diphenhydramine and hydroxyzine, are often used as first-line therapy in atopic dermatitis for their sedative effects, despite the American Academy of Dermatology guidelines highlighting that there is insufficient evidence to support antihistamine use in atopic dermatitis patients except for insomnia secondary to itch.10
Tricyclic antidepressants, such as doxepin and trimipramine, are used in low doses, but these should be avoided in the elderly because of their anticholinergic effects.
Mirtazapine is an adrenergic, histaminergic and serotonergic antagonist which may be useful in atopic dermatitis due to its antipruritic, anxiolytic, and sedative effects.11
Benzodiazepinesincrease the frequency of the γ-aminobutyric acid (GABA) receptor opening to cause sedation. However, benzodiazepines and nonbenzodiazepine hypnotics may cause respiratory depression, especially in patients with asthma, which is a common comorbidity of atopic dermatitis, and should be avoided in children and older patients because of their addictive potential.12
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