Trazodone ER (Oleptra) for maintence insomnia

[Tripolar]

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I have a patient who did not have good effect with the ambien's, anti-histamines or benzo's so I had tried trazodone and it works wonderfully to knock her out at night. The problem is she consistently only gets 3-4 hours. This is similar to before the medication only she had a hard time falling asleep on top of only getting a few hours.

So the time-to-sleep is much improved but even as dose is higher (100mg after 2 weeks) she cannot get anymore hours. She has no sedation or groggines the next day and loves the medication.

She also has depression which is being worked on in therapy and maybe adding another AD is an option but I am going to go with Oleptra to try help give a little bit more of a steady release of trazodone which works well for her throughout the night and monitor her for sedation the next day. If she tolerates it like she is doing with no sedation I will use this as the antidepressant at 300mgs. Tabs come in scored 150mg and 300mg that can be split.

Its a cool drug, I have always loved trazodone for no weight gain, minimal sexual side-effects, no anti-cholinergic side-effects and non-histamine related hypnotic effect (or minimal anti-histamine contribution compared to alpha 1 antagnoism and 5HT2A antagonism)

Anyone use this?

 

[michaelrack]

sounds interesting; please keep us updated.

I haven't tried this yet; in the past I have had some success with regular trazodone, for which there is some evidence of its use in patients with insomnia associated with depression.

 

[Dapplegrey]

I have no experience with Oleptro but foresee two problems:

1. Cost--will be most likely be in the patient's highest co-pay tier ($40-60)
2. Prior Authorization--will most likely get the dreaded "Prior Authorization Required" fax from the pharmacy within hours of writing the prescription

Other choices are still available.

 

[whopper]

I see no point in giving it unless Trazodone was tried first and Oleptro showed superiority to Trazodone.

With problems sleeping, one should monitor if the problem is falling asleep, staying asleep or both because the choice of med is important based on those factors. Another thing I've seen some doctors miss is trying to discern the cause of the poor sleep. If it's obstructive sleep apnea, for example, the better treatment is weight loss and CPAP, not meds.

Most of my patients that have problems sleeping in outpatient, aside from mental illness is just plain and simple smoking, caffeine use, or they have OSA. I'm hesitant to pull the trigger on a sleep med on outpatients for that reason, especially since sleep hygiene is the preferred treatment. So many patients don't seem to know that smoking cigarettes hurts one's ability to sleep. In inpatient, I'm more prone to give sleep meds because if the problem is bad enough for them to be hospitalized, getting sleep becomes a much more important factor.

 

[Tripolar]

I see no point in giving it unless Trazodone was tried first and Oleptro showed superiority to Trazodone.

With problems sleeping, one should monitor if the problem is falling asleep, staying asleep or both because the choice of med is important based on those factors. Another thing I've seen some doctors miss is trying to discern the cause of the poor sleep. If it's obstructive sleep apnea, for example, the better treatment is weight loss and CPAP, not meds.

Most of my patients that have problems sleeping in outpatient, aside from mental illness is just plain and simple smoking, caffeine use, or they have OSA. I'm hesitant to pull the trigger on a sleep med on outpatients for that reason, especially since sleep hygiene is the preferred treatment. So many patients don't seem to know that smoking cigarettes hurts one's ability to sleep. In inpatient, I'm more prone to give sleep meds because if the problem is bad enough for them to be hospitalized, getting sleep becomes a much more important factor.

Im sorry but did you even read my post? I discuss the role of regular trazodone for her and the maintence phase of sleep being the issue.

Actually sleep hygeine is never an adequate treatment in itself and rarely effective by itself for insomnia so I use it with a medication. Anyway in this case none of those are an issue and yes I addressed all this extremely basic stuff. Should have been more specific in the post.

Was looking for people who actually used it. Post above is completely unhelpful.

Cost is not an issue. These are cash pay wealthy peeps.

 

[whopper]

Yeah I read it.

I have a patient who did not have good effect with the ambien's, anti-histamines or benzo's so I had tried trazodone and it works wonderfully to knock her out at night. The problem is she consistently only gets 3-4 hours. This is similar to before the medication only she had a hard time falling asleep on top of only getting a few hours.

So the time-to-sleep is much improved but even as dose is higher (100mg after 2 weeks) she cannot get anymore hours. She has no sedation or groggines the next day and loves the medication.

And, well the grammar is a bit difficult to make out. If I'm interpreting you right, the time to sleep is better with Oleptra? I read it 3x and I'm not quite sure what you meant. E.g. "a patient who didn't have a good effect with the ambien's."

Actually sleep hygeine is never an adequate treatment in itself and rarely effective

Well hey, per studies it's actually more effective than several meds in the long-term, and it's the recommended first line treatment in several cases. Further, several sleep meds if used long-term could cause problems avoidable with sleep hygiene alone. Sleep meds are often better in getting quick results. There are of course exceptions. E.g. I think most clinicians would reasonably say screw sleep hygiene if someone had poor sleep due to severe depression or bipolar disorder.

Was looking for people who actually used it. Post above is completely unhelpful.

Fair enough. If you don't want an open-ended discussion fine, I get it. No offense meant, but I'll respond spade-for-spade. You want people's input on Oleptra, and I get it if you don't want more than that, but I'll retort that your own post is a bit fuzzy in the beginning, inaccurate in terms of the established guidelines and data, and if you don't want anyone responding at all on anything else on sleep, just say so and I'll shut up.

No offense meant, not trying to be snarky, but I will respond spade-for-spade.

 

[michaelrack]

I

Actually sleep hygeine is never an adequate treatment in itself and rarely effective by itself for insomnia so I use it with a medication. .

Tripolar is basically right about the efficacy of sleep hygiene- it is usually not effective alone for insomnia. Sleep hygiene is an adjunct to other treatments for insomnia, including medication and behavioral therapies (including cognitive behavioral therapy for insomnia).

 

[watto]

Tripolar is basically right about the efficacy of sleep hygiene- it is usually not effective alone for insomnia. Sleep hygiene is an adjunct to other treatments for insomnia, including medication and behavioral therapies (including cognitive behavioral therapy for insomnia).

Yes. Behavioral treatment of insomnia: sleep restriction (extending allowed sleep period only when sleep efficiency is > 85%), stimulus control, relaxation training, and cognitive interventions for sleep-related anxiety, all effective long-term and vastly different from "sleep hygiene" which is usually a list of things not to do on a sheet of paper, most of which are only contributors to the sleep disturbance and not the primary culprit.

I was going to ask if this lady was postmenopausal, might be having REM-related respiratory events...so many times you see the "I always wake up after 3-4 hours" and it's this postmenopausal UARS vs OSA awakening that is only eliminated with PAP.

 

[Indodo]

I thought trazodone does cause weight gain.

Whats this no weight gain business??


Also, most of the people I give trazodone have a hangover effect. I like ambien/lunesta better.