![]() ![]() These drugs work by blocking the receptors of the neurotransmitter orexin (also known as hypocretin). ĭual orexin receptor antagonist (DORA) drugs are the latest class of drug approved for treatment of chronic insomnia. The use of trazodone for the off-label treatment of insomnia has been steadily increasing. Notably, off-label prescription of trazodone for insomnia has far exceeded the drug’s rate of prescription for its approved use as an antidepressant. In fact, trazodone is one of the most prescribed treatments for chronic insomnia in general, despite the fact that it is being used off-label and limited data exist characterizing its efficacy and side-effect profile in the treatment of insomnia. ![]() One of the most commonly prescribed medications for treatment of insomnia, trazodone, is the focus of this article. The primary side-effects are psychomotor impairment, daytime sedation, dizziness, and abuse liability and these medications are classified as DEA (Drug Enforcement Administration) Schedule IV medications. All of the Z drugs and several benzodiazepines (triazolam, flurazepam, estazolam, quazepam, and temazepam) are FDA-approved for the treatment of insomnia, with well-established efficacy and side-effects profiles. Benzodiazepines and “Z drugs” (so-called due to their names: zolpidem, zaleplon, and eszopiclone) belong to the GABA-A receptor modulator class of medications. There are a number of different types of medications that can be used for the treatment of insomnia. There is a large unmet need to better educate the public on the gravity of sleep disorders and to better inform healthcare professionals on the benefits and risks of the wide variety of insomnia treatments that are now available. Unfortunately, there is a widespread lack of knowledge within the general population regarding how serious the impacts of insomnia can be, and patients often have the condition for years before seeking treatment. It represents a significant public health problem, owing to its association with significant impairment in quality of life and function and economic burden. Insomnia, defined as self-reported difficulty falling or staying asleep, accompanied by daytime impairment occurring at least 3 times per week for at least 3 months, is the most prevalent sleep disorder. Sleep disorders are extremely common, affecting about 30% of the general population worldwide. While the majority of field survey responders disagreed with the statement, the majority of panel members agreed with the statement based on the limited published evidence supporting trazodone as a first-line agent as they understood the term “first-line agent”. This paper reports on the evidence review, the panel discussion, and the panel’s and healthcare professionals’ ratings of the statement’s acceptability. Subsequently, a meeting with a seven-member panel of key opinion leaders was held to discuss published evidence in support and against the statement. This clinical appraisal critically reviews the scientific literature on trazodone as a first-line treatment for insomnia, with the focus statement “ Trazodone should never be used as a first-line medication for insomnia.” In addition, field surveys were sent to practicing physicians, psychiatrists, and sleep specialists to assess general support for this statement. There was a significant decrease in the number of awakenings in patients receiving trazodone compared with placebo (SMD = −0.51 95% CI, −0.97 to −0.05), with no significant differences in other secondary outcomes.Trazodone is one of the most commonly used prescription medications for insomnia however, some recent clinical guidelines do not recommend its use for treating insomnia. Secondary outcomes included sleep latency, total sleep time, number of awakenings, and waking time after sleep onset. When trazodone was compared with placebo, there was no significant improvement in sleep efficiency (standardized mean difference = 0.09 95% CI, −0.19 to 0.38 P =.53) and small to no change in sleep quality (SMD = −0.41 95% CI, −0.82 to −0.00 P =.05). Primary outcomes included sleep efficiency and self-reported sleep quality. 1 Patients with insomnia were included regardless of whether it was primary or secondary insomnia. Six trials took place in the outpatient setting, and one trial combined inpatients and outpatients. A 2018 meta-analysis examining the use of trazodone for insomnia included seven RCTs with 429 adults (mean age = 46.1 years range = 38.2 to 81 years 58.2% female).
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |