Can a patient taking clonazepam (Klonopin) also take trazodone (Desyrel) for sleep?

From the Guidelines

It is not recommended for a patient taking clonazepam to also take trazodone for sleep due to the potential for increased sedation, dizziness, confusion, and impaired coordination, as well as the adverse effect profile of trazodone outweighing its benefits in treating chronic insomnia disorder 1.

Key Considerations

• The combination of clonazepam and trazodone can lead to increased risks of adverse events, including falls, cognitive impairment, and dependency 1.
• Trazodone has a low-quality evidence supporting its efficacy in treating chronic insomnia disorder, and its adverse effect profile outweighs its benefits 1.
• Clonazepam is a benzodiazepine that enhances GABA effects in the brain, while trazodone is an antidepressant that affects serotonin levels and has sedating properties.

Alternative Options

• Other treatment options for insomnia disorder, such as nonbenzodiazepine BZRAs, may be considered under direct medical supervision 1.
• Melatonin, a dietary supplement, may be an alternative option for treating insomnia disorder, with a starting dose of 3 mg taken at bedtime 1.

Important Precautions

• Patients taking clonazepam and trazodone should avoid alcohol and be cautious with activities requiring alertness until they understand how this combination affects them.
• Never adjust dosages or stop either medication without medical guidance, as both can cause withdrawal symptoms if discontinued abruptly.
• Patients should inform their doctor about all medications they're taking, including over-the-counter products and supplements.

From the Research

Patient Considerations

• When considering the use of trazodone (Desyrel) for sleep in a patient already taking clonazepam (Klonopin), it is essential to evaluate the potential interactions and efficacy of this combination 2, 3.
• Trazodone has been shown to be effective in improving sleep quality in patients with primary insomnia and those with neurocognitive disorders, including Parkinson's disease 4, 2, 5.
• Clonazepam, on the other hand, is often used to treat rapid eye movement sleep behavior disorder and restless legs syndrome in patients with neurocognitive disorders 6.

Efficacy and Safety

• Studies have demonstrated that trazodone can be used safely and effectively in combination with other medications, including clonazepam, to improve sleep quality in patients with sleep disorders 2, 3.
• However, it is crucial to monitor patients for potential adverse effects, such as cognitive and motor impairments, which have been associated with trazodone use 3.
• The combination of trazodone and clonazepam may be beneficial for patients with sleep maintenance insomnia, especially those with comorbid mental disorders or those treated with activating antidepressants 5.

Treatment Approach

• A comprehensive treatment approach should include a thorough evaluation of the patient's sleep disorders, as well as any comorbidities that may be interfering with sleep 6.
• Cognitive-behavioral therapy for insomnia (CBT-I) may be a useful adjunct to pharmacological treatment, including trazodone and clonazepam 4.
• The dosage and timing of trazodone administration should be optimized to minimize potential adverse effects and maximize efficacy, with a typical dose of 50mg at bedtime 2, 3.