From the Guidelines
Prescribing trazodone at bedtime for a patient taking methadone during the day is not recommended due to potential drug interactions and adverse effects. The combination of trazodone and methadone can increase the risk of sedation, respiratory depression, and cardiac effects, particularly in patients with sleep apnea, respiratory conditions, or those on other sedating medications 1.
Alternative Sleep Aids
Instead, alternative sleep aids that may be safer include:
- Non-pharmacological approaches like sleep hygiene education
- Cognitive behavioral therapy for insomnia
- Medications with fewer interactions such as:
- Melatonin (1-5mg)
- Mirtazapine (7.5-15mg)
- Low-dose doxepin (3-6mg)
Monitoring and Consultation
If insomnia persists despite these measures, consider consulting with a psychiatrist or addiction specialist for personalized recommendations. It is essential to monitor patients for excessive sedation, respiratory depression, and cardiac effects when prescribing any sleep aid, especially in combination with methadone 1.
Evidence-Based Recommendation
The work group advised against the use of benzodiazepines or trazodone for the treatment of chronic insomnia disorder due to the widely known harms and adverse effects of these medications, which substantially outweigh their benefits 1. Therefore, it is recommended to avoid prescribing trazodone at bedtime for patients taking methadone during the day and instead opt for alternative sleep aids with fewer interactions and adverse effects.
From the Research
Safety of Prescribing Trazodone with Methadone
- The safety of prescribing trazodone at bedtime to a client taking methadone during the day for sleep assistance is a concern due to potential interactions and side effects 2.
- A study published in 2012 found that trazodone did not improve subjective or objective sleep in methadone-maintained persons with sleep disturbance, and its effect on mean PSQI scores during the 6-month follow-up was not statistically significant (p=.10) 2.
- Another study published in 2009 discussed the treatment of sleep dysfunction and psychiatric disorders, including the use of sedating antidepressants like trazodone for insomnia, but did not specifically address the interaction between trazodone and methadone 3.
- There is limited research on the specific interaction between trazodone and methadone, but it is known that methadone can cause sleep disturbances, and trazodone is sometimes prescribed to treat insomnia 4, 5.
- The decision to prescribe trazodone to a client taking methadone should be made on a case-by-case basis, considering the potential risks and benefits, as well as alternative treatments for sleep disturbance 2.
Alternative Treatments for Sleep Disturbance
- Cognitive-behavioral therapy for insomnia (CBTI) has been shown to be effective in improving sleep quality in patients undergoing methadone maintenance therapy 4.
- Other pharmacologic and non-pharmacologic treatments, such as melatonin, benzodiazepines, and lifestyle changes, may also be effective in treating sleep disturbance in this population 3, 6.
- Further research is needed to investigate the safety and efficacy of trazodone and other treatments for sleep disturbance in clients taking methadone 2.