From the Guidelines
No, it is not appropriate to initiate Trazodone for insomnia in a 92-year-old elderly female with recent onset psychotic symptoms.
Reasons for this decision
- The American Academy of Sleep Medicine suggests that clinicians not use trazodone as a treatment for sleep onset or sleep maintenance insomnia in adults 1.
- The 2019 U.S. Department of Veterans Affairs and U.S. Department of Defense clinical practice guidelines also advise against the use of trazodone for treatment of chronic insomnia disorder, citing its adverse effect profile and low-quality evidence supporting its efficacy 1.
- Key concerns with trazodone include its potential to cause falls and cognitive impairment in older patients, which is particularly relevant in this case given the patient's age and recent onset psychotic symptoms.
- Alternative treatments for insomnia, such as suvorexant, eszopiclone, zaleplon, zolpidem, triazolam, temazepam, ramelteon, and doxepin, may be considered, but should be chosen based on the individual patient's circumstances and under the guidance of a clinician 1.
From the Research
Considerations for Initiating Trazodone in a 92-Year-Old Elderly Female
- The patient's recent onset psychotic symptoms may be a concern when considering trazodone, as there is evidence suggesting that trazodone can exacerbate psychotic symptoms 2.
- Trazodone is often used off-label for insomnia, and its efficacy for this purpose has been demonstrated in various studies, including in older adults 3, 4.
- However, the safety profile of trazodone in older adults, particularly at high doses or in combination with other medications, is a concern, with potential side effects including falls, cognitive impairment, and parkinsonism 5, 4, 6.
- The patient's age and potential for polypharmacy may increase the risk of adverse effects, and careful consideration of the benefits and risks is necessary before initiating trazodone 6.
Potential Risks and Benefits
- Benefits: trazodone may be effective in improving sleep quality and reducing insomnia symptoms 3, 5, 4.
- Risks: trazodone may exacerbate psychotic symptoms 2, increase the risk of falls 4, 6, and cause cognitive impairment or parkinsonism 5, 6.
- The decision to initiate trazodone should be made on a case-by-case basis, taking into account the patient's individual needs, medical history, and potential risks and benefits.