From the Guidelines
For acute pain with a bone fracture, a dose of 50 mg of trazodone is recommended for sleep, as it has been shown to reduce sleep latency by 10 minutes and wake after sleep onset by 8 minutes, compared to placebo 1. This dose is based on trials of 50 mg doses of trazodone, which demonstrated its efficacy in improving sleep outcomes. Some key points to consider when prescribing trazodone for sleep in this context include:
- Starting with a lower dose, such as 25-50 mg, to minimize side effects like morning drowsiness
- Taking the medication 30-60 minutes before bedtime to allow for optimal sleep promotion
- Gradually increasing the dose to 100 mg if needed, but avoiding higher doses unless necessary
- Continuing appropriate pain management for the fracture to ensure that uncontrolled pain does not interfere with sleep
- Starting with a lower dose of 25 mg in elderly patients or those with liver impairment
- Tapering the medication gradually under medical supervision if it needs to be stopped after regular use. It's also important to note that trazodone should be taken with a small snack to reduce the risk of dizziness, and patients should allow for 7-8 hours of sleep time after taking it to avoid daytime sedation.
From the FDA Drug Label
- Dosage and Administration 2. 1 Dose Selection An initial dose of 150 mg/day in divided doses is suggested. The dosage should be initiated at a low-dose and increased gradually, noting the clinical response and any evidence of intolerance. Occurrence of drowsiness may require the administration of a major portion of the daily dose at bedtime or a reduction of dosage.
The FDA drug label does not answer the question.
From the Research
Trazodone Dosage for Sleep with Acute Pain and Bone Fracture
- The provided studies do not directly address the optimal dose of trazodone for sleep in patients with acute pain and bone fractures.
- However, one study 2 investigated the use of trazodone in combination with cognitive behavior therapy for primary insomnia, and found that a dose of 100mg trazodone significantly improved sleep outcomes, including sleep latency, sleep efficiency, and total sleep time.
- It is essential to note that this study was conducted in non-depressed patients with primary insomnia, and the results may not be directly applicable to patients with acute pain and bone fractures.
- The other studies 3, 4, 5, 6 focus on the management of pain associated with fractures, but do not provide information on the use of trazodone for sleep in this context.
- Therefore, there is limited evidence to support a specific dose of trazodone for sleep in patients with acute pain and bone fractures, and further research is needed to determine the optimal dosage and treatment approach.