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 — Zaleplon(click to collapse)
1/4 selected
Zaleplon
Sonata
Pyrazolopyrimidine Z-Drug (Non-BZD) · C-IV
FDA-approved indications
- Short-term treatment of insomnia (sleep-onset)
Off-label uses
- Middle-of-night dosing for nighttime awakening (can dose after going to bed)
MechanismSelective GABA-A omega-1 receptor agonist
Half-life~1 hour (mean)
Decision GuideWhen to pick each / when to consider an alternative
Zaleplon
Consider when
- Middle-of-night awakening — ultra-short t½ (~1h) allows dosing after going to bed with no next-day residual sedation
- Next-day impairment is paramount concern — lowest residual sedation risk of any Z-drug; best tolerability in Lancet 2022 NMA
- Sleep-onset insomnia in elderly — most effective agent for SOL reduction in elderly-specific NMA (~15–20 min; Chiu et al.)
- Patient on CYP3A4 inhibitors — primary aldehyde oxidase metabolism; CYP3A4 inhibitors cause only modest AUC change vs dangerous increases with zolpidem/triazolam
- +1 more
Consider an alternative when
- Sleep-maintenance insomnia — zaleplon does not increase total sleep time or decrease WASO; onset-only agent
- Both sleep-onset AND maintenance needed — eszopiclone or DORAs (lemborexant, suvorexant) cover both domains
- Severe hepatic impairment — contraindicated; clearance reduced 87% in decompensated cirrhosis (more sensitive than zolpidem/eszopiclone)
- Patient on cimetidine — 85% AUC increase (inhibits both aldehyde oxidase and CYP3A4); max dose 5 mg
- +1 more
| Axis | Zaleplon Non-benzodiazepine Hypnotic |
|---|---|
| Boxed Warnings | |
Respiratory depression (opioid / CNS depressant co-use) | |
Complex sleep behaviors | |
| CNS | |
Cognitive dulling / anterograde amnesia | |
Headache | |
| GI | |
Nausea / GI (general) | |
| Hepatic | |
Liver enzymes / hepatotoxicity | |
| Discontinuation | |
Withdrawal / discontinuation | |