prazosinAdjunctive therapyBrands: MINIPRESS | Hypertension (label); commonly used off label for PTSD-related nightmares. View labelExact | PTSD nightmares (off label): start 1 mg at bedtime; titrate gradually (often in 1 mg increments) based on nightmare frequency and tolerability. | Alpha-1 adrenergic antagonist; reduces sympathetic tone (vasodilation). | Hepatic | Single-dose range 2–3 h | No | — | - Check blood pressure (including orthostatic vitals) during initiation and after dose increases; counsel hydration and slow positional changes.
- Reassess falls risk and co-prescribed sedatives/antihypertensives; adjust titration speed accordingly.
- Define a reassessment milestone for nightmare response; taper and stop if benefit is unclear after an adequate trial.
- If doses are missed for several days, restart low and retitrate to reduce first-dose syncope risk.
| No | 2025-12-28 |
|---|
trazodoneAdjunctive therapyBrands: DESYREL, OLEPTRO | Major depressive disorder (label); commonly used off label for insomnia. View labelExact | Insomnia (off label): start 25–50 mg at bedtime; typical 50–150 mg nightly based on tolerability; reassess frequently and avoid open-ended dose escalation. | Serotonin antagonist and reuptake inhibitor (SARI); 5-HT2 antagonism with weak SERT inhibition plus H1/α1 effects. | CYP3A4 | Single-dose mean 7 h; Single-dose range 5–13 h | No | | - Monitor orthostatic symptoms and falls risk during initiation and after dose increases, especially in older adults or those on antihypertensives.
- Reassess mood and suicidality during antidepressant initiation and titration; ensure the dose matches the target (sleep vs depression).
- Review QT-risk co-medications and consider ECG/electrolytes when risk factors stack.
- If used primarily for insomnia, document a stop plan and reassess regularly rather than continuing indefinitely.
| No | 2026-02-22 |
|---|
doxepinAdjunctive therapyBrands: Sinequan, Silenor | Depression and anxiety; low-dose formulation approved for insomnia. View labelExact | Depression/anxiety: typical start is 25–50 mg at bedtime; titrate by 25–50 mg every 3–4 days to 75–150 mg/day (single HS dose or divided BID). Max 300 mg/day inpatient with ECG monitoring. | Tricyclic antidepressant; strong antihistamine with serotonin and norepinephrine reuptake inhibition. | CYP2D6, CYP2C19 | Single-dose mean 28 h; Steady-state mean 31 h | 150–250 ng/mL | | - Sedation, next-day impairment, and falls risk (especially in older adults); driving and occupational safety are often reassessed after dose changes.
- Orthostatic vitals during titration and when combined with other hypotensive medications; hydration and slow position changes are commonly emphasized.
- Anticholinergic burden (constipation, urinary retention, confusion); bowel regimen planning and avoiding additive anticholinergic polypharmacy are common considerations when feasible.
- ECG monitoring for patients with cardiac disease, electrolyte abnormalities, or higher antidepressant doses; repeat ECGs are often considered when adding other QT-active agents.
- Therapeutic drug monitoring can be helpful in higher-dose depression regimens, drug interactions (CYP2D6/2C19 inhibitors), unexpected nonresponse, or suspected toxicity.
- Mood activation (mania/hypomania) in bipolar-spectrum illness and suicidal thinking during initiation; coordination via the bipolar disorder hub can support planning.
| No | 2025-12-29 |
|---|
| Anxiety symptoms (label); pruritus; pre/postoperative sedation (label varies by product). View labelExact | Anxiety/acute distress (off label patterns vary): 25–50 mg every 6–8 hours as needed; consider 10–25 mg starting doses in older adults or high fall risk. | First-generation antihistamine (H1 antagonist) with sedating and anxiolytic effects; anticholinergic/antiemetic properties. | Hepatic | No | | - Sedation, falls, and driving impairment are often reassessed after initiation and during dose changes—especially in older adults.
- Anticholinergic effects (constipation, urinary retention, confusion) are commonly monitored; total anticholinergic burden is minimized when possible.
- QT risk: QT-prolonging co-medications and electrolytes are typically reviewed, and baseline ECGs are often considered when risk factors stack.
- If use becomes frequent, the diagnosis is often revisited and plans may shift toward long-term anxiety treatment rather than continued PRN escalation.
| No | 2025-12-28 |
|---|