Can Trazodone (trazodone) be taken as needed (prn) for insomnia?

From the Guidelines

Trazodone should not be taken as needed (PRN) for insomnia due to its adverse effect profile and lack of strong evidence supporting its efficacy for this indication. According to a systematic review published in the Annals of Internal Medicine 1, trazodone was not found to be more effective than placebo in improving sleep efficiency, sleep onset latency, total sleep time, or wake after sleep onset in patients with chronic insomnia. Although trazodone was more effective at improving subjective sleep quality, the low-quality evidence supporting its efficacy was outweighed by its adverse effect profile. The work group advised against the use of trazodone for treatment of chronic insomnia disorder due to its potential harms, including risk for dependency, falls, and cognitive impairment in older patients.

Some key points to consider when evaluating the use of trazodone for insomnia include:

• The lack of strong evidence supporting its efficacy for this indication
• The potential for adverse effects, such as morning drowsiness, dizziness, and dry mouth
• The recommendation against its use by the work group due to its potential harms
• The availability of alternative treatments, such as cognitive behavioral therapy for insomnia (CBT-I) and other pharmacologic agents, that may be more effective and have a more favorable safety profile.

It's essential to consult with a healthcare provider before using trazodone PRN, as they can provide personalized recommendations based on individual health situations and other medications being taken. The American College of Physicians recommends that clinicians use a shared decision-making approach, including a discussion of the benefits, harms, and costs of short-term use of medications, to decide whether to add pharmacological therapy in adults with chronic insomnia disorder in whom CBT-I alone was unsuccessful 1.

From the FDA Drug Label

Occurrence of drowsiness may require the administration of a major portion of the daily dose at bedtime The FDA drug label does not answer the question of whether trazodone can be taken prn for insomnia.

From the Research

Trazodone for Insomnia

• Trazodone is often used off-label for the treatment of insomnia, with evidence suggesting its efficacy and safety for this purpose 2.
• The medication has been shown to be effective for both primary and secondary insomnia, including symptoms resulting from depression, dementia, and other conditions 2.
• Trazodone can be used at low doses for the treatment of insomnia, with side effects being dose-dependent and the most common being drowsiness 2.

Comparison with Cognitive-Behavioral Therapy

• Cognitive-behavioral therapy for insomnia (CBT-i) is a highly effective treatment for chronic insomnia, with results equivalent to sleep medication and no side effects 3, 4.
• CBT-i has been shown to produce sustained benefits without the risk of tolerance or adverse effects associated with pharmacologic approaches 4.
• A study comparing trazodone with CBT-i found that trazodone decreased fast-frequency EEG activity during non-rapid eye movement sleep, while CBT-i did not have a significant impact on EEG activity 5.

Dosage and Administration

• Trazodone can be taken at doses of 100mg or more for the treatment of insomnia, although lower doses may also be effective 2, 6.
• The medication can be taken as needed (prn) for insomnia, although the optimal dosage and administration schedule may vary depending on individual patient needs and responses 2, 6.
• A study using 100mg of trazodone combined with CBT found significant improvements in sleep latency, sleep efficiency, and total sleep time, as well as an increase in slow wave sleep duration 6.