PsychRounds: The Psychiatry Podcast The Sleep Series: H1 Antagonists (Trazodone, Benadryl, Doxepin)
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Oct 16, 2024 Dive into the world of sleep pharmacology and the role of H1 antagonists in treating insomnia. Trazodone’s mixed efficacy sparks a lively discussion on its clinical use and potential side effects. Discover the nuances of doxepin, the only FDA-approved sleep aid in this category. The dangers of rebound insomnia and the implications of sedating antipsychotics for sleep are critically examined. Experts also highlight the importance of sleep hygiene and cognitive behavioral therapy as vital components in managing sleep disorders.
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Histamine H1 Receptor Role
- Higher histamine activity at the H1 receptor causes wakefulness and arousal.
- Blocking H1 receptors with medication induces sleepiness and helps treat insomnia.
Trazodone's Sleep Efficacy and Risks
- Trazodone is widely used for sleep despite limited and unimpressive long-term efficacy.
- Its well-known risk is rare but serious priapism, which is a medical emergency.
Trazodone Dosing for Sleep
- Use trazodone for insomnia at 25 to 150 mg at night, starting low and titrating slowly.
- Higher doses act as antidepressants but are less commonly used for that purpose.