PHRM 211 Lecture Notes - Lecture 10: Doxepin, Trazodone, Mirtazapine
Document Summary
All are considered off-label use for insomnia, except doxepin (approved by health canada for sleep maintenance, but rarely used). Dosage : 25-50 mg po qhs prn to start, can increase to usual dose of 50-100 mg qhs. Notes : increased half-life in the elderly ( adrs); minimal effect on sleep architecture. Dosage (oral): 3. 75-15 mg po qhs to start, can increase to 15-45 mg/day. Notes : inverse relationship between dose and sedation ( dose = sedating) Dosage (oral): 3-6 mg po 30 min before hs prn. Notes : approved by hc for sleep maintenance of insomnia; tca (antidepressant doses are around 150-300 mg daily) Cochrane review 2018 23 rcts; mostly small studies with short-term follow up and design limitations. Lack of evidence; in absence of comorbidities, antidepressants should not be used solely to treat insomnia; may consider trazodone (not officially indicated), but low doses may be used. Take advantage of antihistaminergic, anticholinergic, and serotonergic activity to cause sedation.
