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Melatonin is a supplement that is most often used for insomnia. I see patients take this supplement on a daily and it is also a frequent recommendation of many providers. Here are a few melatonin clinical pearls that I would recommend you pay attention to when you see a patient taking it. My first recommendation […]
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Doxepin is a tricyclic antidepressant first approved for the treatment of depression in 1969 by the FDA. Tricyclic antidepressants are famous for their anticholinergic adverse effects including sedation and have been replaced by better-tolerated medications as first-line agents for depression. Doxepin pharmacodynamics helps determine what indications it may be beneficial for. Doxepin specifically, has a […]
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Mirtazapine is commonly used in elderly patients with depression who are also suffering from insomnia. Mirtazapine is often chosen because it is much safer than benzodiazepines, “z-drugs”, and antipsychotics. The mechanisms of mirtazapine (podcast episode on the pharmacology) include the release of norepinephrine via presynaptic adrenergic auto-receptor blockade, increased serotonin production through stimulation of adrenoreceptors […]
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YS is a 79-year-old female with a medical history of osteoarthritis, insomnia, CVD, GERD, constipation, dementia, and falls. Her current medication list includes donepezil, Senna-S, lisinopril, zolpidem, amitriptyline, baby aspirin, acetaminophen, and omeprazole. Over the last three months, she has had a total of 7 falls and one that resulted in a fractured wrist. Because […]
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