Discussion response
Geriatrics & Insomnia
Teresa Smith
Geriatrics & Insomnia
There are many different drugs that are used for the treatment of Insomnia in all populations including the geriatric population. My assessment risk for an FDA-approved drug for the treatment of insomnia in geriatrics is Quviviq 25-50 mg nightly. My reason for selecting the new FDA-approved drug for insomnia is that it allows adults and older adults to go to sleep and stay asleep throughout the night safely and allows them to wake up feeling more refreshed. Studies also have shown fewer falls in older individuals when using Quviviq and appear to be one of the better choices for the geriatric population. (McCarthy, 2022)
Individuals who decide to take Quviviq should let their provider know about any health conditions they may have. The benefits of taking Quviviq in older individuals include a more sound and restful night’s sleep without waking during the night, and a more refreshed feeling the next morning. Individuals should not drink alcohol while taking Quviviq. Drinking alcoholic beverages while taking Quviviq may cause drowsiness or dizziness. Studies have shown that some other side effects may include drowsiness after waking the next day. If this occurs individuals should consult with their physician, and should not operate heavy machinery, or any activities that may cause physical harm. (Drugs.com, 2023)
An option for an off-label drug that is effective in treating insomnia in the geriatric population with fewer side effects may include Trazodone an SSRI (antidepressant), used to treat depression. According to Cuomo et al., 2021, “The peculiar multifunctional pharmacological profile of trazodone explains its efficacy to improve Major Depressive Disease (MDD), a very heterogeneous condition often associated with anxiety, insomnia, agitation, nervousness, or irritability. In such a context, trazodone can represent an efficacious treatment for insomnia in the geriatric population. The initial dose of trazodone with geriatrics should range from 25 to 50 mg/day” (Cuomo et al., 2021).
My assessment risk for selecting trazodone as my off-label treatment for insomnia in the elderly population is that trazodone as an SSRI (antidepressant) has benefits for treating depression, anxiety, and sleep disorders effectively with fewer side effects than benzodiazepines. (Atkin et al., 2018) According to Cuomo et al., 2021, “Trazodone is clinically useful in elderly patients, including people with agitated behavior, because of its specific anxiolytic and sleep normalizing effect and excellent safety and tolerability. Trazodone is valuable for treating depression associated with insomnia in patients with chronic neurodegenerative disorders, particularly in the early phases of neurodegeneration. However, aging does not significantly impair liver metabolism by CYP3A4, while reduced renal clearance may increase trazodone blood concentrations. Studies have shown that trazodone should be used with caution to reduce the risk of priapism in patients affected by multiple myeloma, sickle cell anemia, hypercoagulable states, leukemia, autonomic nervous system dysfunctions, and anatomical deformation of the penis or in combination with SSRIs, cocaine, or atypical antipsychotics” (Cuomo et al., 2021). The geriatric population should also be monitored for headaches, hypotension, and dizziness could increase the risk of falls. (Cuomo et al., 2021)
Melatonin is a good over-the-counter drug that can be used with the geriatric population who suffer from insomnia. My risk assessment with melatonin is that is has a decrease in side effects related to other prescription and off-label drugs that are used for insomnia in older adults. Individuals should be monitored for side effects and proper dosing. According to Abad & Guilleminault, 2018, “Melatonin slightly improves sleep onset and sleep duration, but product quality and efficacy may vary as with many over-the-counter drugs” (Abad & Guilleminault).
References
Abad, V. C., & Guilleminault, C. (2018). Insomnia in elderly patients: Recommendations for pharmacological management.
Drugs & Aging,
35(9), 791–817. Retrieved
January 23, 2023, from
https://doi.org/10.1007/s40266-018-0569-8Links to an external site.
Atkin, T., Comai, S., & Gobbi, G. (2018). Drugs for insomnia beyond benzodiazepines: Pharmacology, clinical applications, and discovery.
Pharmacological Reviews,
70(2), 197–245. Retrieved January 23, 2023, from
https://doi.org/10.1124/pr.117.014381Links to an external site.
Cuomo, A., Bianchetti, A., Cagnin, A., De Berardis, D., Di Fazio, I., Antonelli Incalzi, R., Marra, C., Neviani, F., & Nicoletti, F. (2021). Trazodone: A multifunctional
antidepressant. evaluation of its properties and real-world use.
Journal of Gerontology and Geriatrics,
69(2), 120–129. Retrieved January 23, 2023, from
https://doi.org/10.36150/2499-6564-n320Links to an external site.
Drugs.com. (2023, January 15).
Quviviq. Retrieved January23, 2023, from
https://www.drugs.com/quviviq.htmlLinks to an external site.
McCarthy, M. (2022, January 13).
FDA approves new insomnia drug that may improve sleep with less grogginess. Retrieved January 23, 2023, from
https://www.healthline.com/health-news/fda-approves-new-insomnia-drug-that-may-improve-sleep-with-less-grogginessLinks to an external site.
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