Insomnia is a sneaky condition that can lead to polypharmacy. Many of the medications used in the management of insomnia can work for a short period of time, but I’ve seen so many cases where the effects wear off over time. Always remember to do our due diligence on non-pharmacologic interventions! Here’s a case scenario where insomnia led to polypharmacy.
A 77-year-old resident at a long term care facility is having trouble falling and staying asleep. He discusses this with his primary care provider who prescribes trazodone 25 mg at bedtime. This is beneficial for about 2-3 weeks, but the nursing staff recognizes that he is still complaining about his sleep.
In an honest effort to help the resident’s insomnia, the nursing staff fax information to the PCP regarding insomnia and that he has been up a lot recently and would like a medication to help sleep. They do note in the fax that he is on trazodone but did not state a dose or when it was started. In response to the fax, the PCP prescribes melatonin 3 mg at bedtime.
In the midst of the fax and new prescription, the trazodone was never reassessed or even considered for an increase. I’ve seen scenarios similar to this numerous times. A complete review of all medications is so critical prior to prescribing new ones! Here’s another polypharmacy case review from the past!