Sleep Medications and Women: a Review of Issues to Consider for Optimizing the Care of Women with Sleep Disorders

Certain medications exhibit sex-specific pharmacological profiles. It is, therefore, imperative to understand their unique pharmacokinetic properties to optimize women’s health. Two such medications that are commonly used in sleep medicine are zolpidem and modafinil/armodafinil. The first is a sedative hypnotic while the latter, in both its incarnations, a wake-promoting agent. The slower clearance of these medications and higher serum concentrations after dosing in women are independent of weight and have to do with the impact of estrogen on the liver enzymes involved in the metabolism of these medications. Below, we summarize and discuss the data that is available on the sex-specific dosing of zolpidem, which in women, by FDA recommendations, is half of what is recommended in men. We also discuss the reasons behind the interaction of hormonal birth control and modafinil/armodafinil and rate of contraceptive failure when hormonal birth control is used with this wake-promoting agent.

Duke Scholars

Author Andrew Darrell Krystal Psychiatry & Behavioral Sciences, Behavioral Medicine & Neur ...