Case Study: Pharmacologic Approaches to the Treatment of Insomnia in a Younger Adult
Insomnia
31-year-old Male
Decision Point One
Trazodone 50 mg po at bedtime
RESULTS OF DECISION POINT ONE
Patient returns to clinic in 2 weeks
Patient states medication works well but gives him an unpleasant side effect of an erection lasting approximately 15 minutes after waking
Patient states this makes it difficult to get ready for work or go downstairs and have coffee with his girlfriend and daughter in the morning
Case Study: Pharmacologic Approaches to the Treatment of Insomnia in a Younger Adult
Patient denies auditory/visual hallucinations and is future oriented
Decision Point Two
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Explain that an erection lasting 15 minutes is not considered a priapism and should diminish over time, continue with current dose
RESULTS OF DECISION POINT TWO
Patient returns to clinic in 2 weeks
Patient states priapism has diminished over time
Patient denies auditory/visual hallucinations and is future oriented
Patient states trazodone is effective at 50 mg dose but sometimes wakes up following day with next-day drowsiness
Patient denies auditory/visual hallucinations and is future oriented
Decision Point Three
Continue dose.
Explain to patient
he may split the 50 mg tablet in half. The decreased dose should minimize next-day drowsiness. Follow up in 4 weeks
Guidance to Student
Trazodone is a selective serotonin reuptake inhibitor that has a low side effect profile. It would not be prudent to prescribe sonata as it carries with it the risk of complex sleep behaviors. Hydroxyzine is an antihistamine with strong sedative properties. However, many patients complain of anticholinergic adverse effects the following morning, such as Xerostomia and Xerophthalmia Case Study: Pharmacologic Approaches to the Treatment of Insomnia in a Younger Adult.
The patient is presenting with excessive somnolence. It would be prudent to reduce the dose of trazodone by 50% and reassess in 4 weeks.
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Case Study: Pharmacologic Approaches to the Treatment of Insomnia in a Younger Adult
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