Drug Comparison
For educational purposes only — a decision-support tool, not a substitute for clinical judgment.
Side-by-side rubric across 96 psychiatric medications. Every rating traces to a verbatim primary-source quote — click any cell to see it.
How to read this tool ▾
Rating scale
– Favorable / lower than class baseline
± Minimal / equivocal
+ Low / uncommon
++ Moderate / common
+++ High / very common
++++ Very high / class-outlier
Frequency vs severity
F = frequency, S = severity. Each gets its own pill colored on the same traffic-light scale: green → blue → yellow → orange → red. Click any cell for incidence percentages and NNH.
Evidence tier
A Network meta-analysis / RCT / FDA label
B Cohort / registry / pooled label data
C Expert review / textbook / case series
Sourcing
Click any cell to see the verbatim source quote and citation. Missing data shows n/a.
Data depth
++ Graded — frequency + severity, primary-source traces
+ FDA label — §6 frequency only (dashed border). Click for sub-types.
Blank — not yet checked (not “absent”)
–±++++++++++ABCF = frequency · S = severity · Dashed border = FDA label only · Click cell for details
1 drug selected — Ramelteon(click to collapse)
1/4 selected
Ramelteon
Rozerem
Melatonin Receptor Agonist
FDA-approved indications
- Insomnia characterized by difficulty with sleep onset (not for sleep maintenance)
Off-label uses
- Circadian rhythm disorders (shift work, jet lag)
- Delirium prevention in hospitalized elderly (emerging evidence)
- Long-term insomnia (off-label duration — FDA labeled for short-term only)
MechanismMT1 and MT2 melatonin receptor agonist
Half-life~1-2.6 hours (parent drug); M-II metabolite 2-5 hours
Decision GuideWhen to pick each / when to consider an alternative
Ramelteon
Consider when
- Abuse or dependence risk must be zero — only non-scheduled (non-DEA) prescription hypnotic; no self-administration in primate studies
- Sleep-onset insomnia in patient with SUD history — no abuse potential, no withdrawal syndrome, no rebound insomnia demonstrated
- Elderly insomnia — no balance or memory impairment at 8 mg in trials; not Beers-listed; AGS-recommended alongside DORAs and low-dose doxepin
- Circadian rhythm disruption contributing to insomnia — selective MT1/MT2 agonist acting on same pathway as endogenous melatonin
- +1 more
Consider an alternative when
- Sleep-maintenance insomnia — ramelteon reduces sleep-onset latency only; no effect on WASO or total sleep time
- Patient on fluvoxamine — absolutely contraindicated (190-fold AUC increase via CYP1A2 inhibition)
- Strong hypnotic effect needed — weakest Rx hypnotic efficacy (SMD 0.12 vs placebo, not significant in Lancet 2022 NMA)
- Severe hepatic impairment — contraindicated; exposure increases >10-fold in moderate impairment due to 1.8% bioavailability
- +1 more
| Axis | Ramelteon Melatonin Agonist |
|---|---|
| Boxed Warnings | |
Suicidality (boxed warning) | |
Complex sleep behaviors | |
| CNS | |
Sedation / somnolence | |
Dizziness | |
Fatigue / lethargy | |
| GI | |
Nausea / GI (general) | |
| Discontinuation | |
Withdrawal / discontinuation | |
| Drug-specific / distinctive axes | |
Reproductive / endocrine effects (W&P §5.5) only in Ramelteon | |