![]() ![]() 18 In the inpatient psychiatric setting, quetiapine, a second-generation antipsychotic, and trazodone, a triazolopyridine antidepressant, are among medications without a US Food and Drug Association-approved indication for insomnia. Additionally, anticholinergic medications may lead to drug-induced delirium. However, antihistamines may not be appropriate for many patients due to potential risks of central and peripheral anticholinergic side effects. Over-the-counter antihistamines such as diphenhydramine and doxylamine are commonly used since it is well known that blockade of the histamine-1 (H 1) receptor leads to sedation. 15-17Īdditionally, due to the habit-forming nature of benzodiazepines and non-benzodiazepine hypnotics, other agents are often used first-line for patients’ insomnia. 14 In addition, use of benzodiazepines is associated with multiple central nervous system-related side effects, including ataxia, falls, and memory impairment (anterograde amnesia), and has led to increases in motor vehicle accidents. However, these drugs are habit forming and may lead to abuse if used long-term. Benzodiazepines and non-benzodiazepine hypnotics, such as zolpidem and eszopiclone, are commonly prescribed. Pharmacologically, many agents are used to induce sleep. 11, 12 Additionally, insomnia is a feature of many psychiatric disorders, including mood disorders, anxiety disorders, and psychosis, 13 which explains the high number of patients who suffer from insomnia in the inpatient psychiatric setting. 6-10 One of the predictive variables for insomnia is the presence of comorbid psychiatric illness. 5 About 20% to 36% of patients are affected by insomnia chronically and report insomnia duration of greater than 1 year. 4 A national survey of noninstitutionalized adults reported a 35% insomnia prevalence rate during the course of the previous year, with insomnia occurring about 50% more often in women. 2, 3 One study noted that the prevalence of insomnia was as high as 69% in primary care patients. It is the most prevalent sleep disorder, occurring in 19% 1 to 50% of clinic patients seeking treatment for other complaints in the primary care or specialty care setting. Submitted: Jaccepted August 14, 2013.Ĭorresponding author: Shadi Doroudgar, PharmD, 1310 Club Dr, Vallejo, CA 94594 ( is a common medical complaint. © Copyright 2013 Physicians Postgraduate Press, Inc. However, patients receiving trazodone experienced more gastrointestinal patient-reported side effects. Patients receiving trazodone reported more side effects of constipation, nausea, and diarrhea than patients receiving quetiapine.Ĭonclusions: With respect to total sleep time and nighttime awakenings, trazodone was a more effective alternative than quetiapine. 04) according to the nursing sleep log report. Patients receiving trazodone experienced fewer mean nighttime awakenings versus those receiving quetiapine (0.52 vs 0.75, respectively, P =. 01) and the nursing sleep logs (9.13 vs 8.68, respectively, P =. Results: On average, mean total sleep time hours were longer among patients receiving trazodone versus those receiving quetiapine according to patients’ subjective reports (7.80 vs 6.75, respectively, P <. Subjective patient interviews and objective nursing sleep log reviews composed the data set. ![]() Exclusion criteria included primary insomnia, pregnancy, concomitant order of trazodone and quetiapine, receiving trazodone or quetiapine up to 2 weeks prior to the study, and inability to coherently communicate. Patient inclusion criteria were age 18 to 65 years, admitted between September 2011 and February 2012, and a physician order for trazodone or quetiapine for insomnia. ![]() Method: Participants were recruited from St Helena Hospital Center for Behavioral Health, Vallejo, California. The objective of this study was to compare the effectiveness of trazodone to quetiapine among inpatient psychiatric patients by measuring the traditional sleep parameters of total sleep time, number of nighttime awakenings, sleep efficiency, sleep latency, length of hospitalization, and patient-reported side effects. The safety and efficacy of trazodone and quetiapine as medications for treatment of insomnia have never been directly contrasted. Non-habit-forming agents such as trazodone and quetiapine are commonly used off-label to treat patients with insomnia. Background: Insomnia is symptomatic of most psychiatric disorders. ![]()
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