If a physician wants to switch a patient from Benzodiazepines (BZD) and ‘z’-drugs to Circadin®, what should be the prescribing regimen?

Discontinuation of BZD should be gradual and well controlled because of the risk of withdrawal symptoms and rebound insomnia ^{60 61} . Circadin^® is indicated as monotherapy for the short-term treatment of primary insomnia characterized by poor quality of sleep in patients who are aged 55 or over.

If the physician wishes to switch a patient from BZD / ‘z’-drugs to Circadin^®, a reduction in BZD / ‘z’-drugs should be gradual⁵⁹. It is recommended to reduce the BZD / ‘z’-drugs dose to 50% in the first few weeks while initiating Circadin^® co-administration and then to 25% for another several weeks. The dose adjustments and duration of the switching have to be according to medical consultation and under medical supervision.

According to Circadin^® SmPC, there can be a pharmacodynamic interaction between BZD / ‘z’-drugs and Circadin^® by which Circadin^® augments the hypnotic effects of the BZD / ‘z’-drugs¹. This is the reason why the dose of BZD / ‘z’-drugs should be reduced to 50% of the usual dose in the first weeks of initiation of Circadin^® co-administration while maintaining good sleep.