Trazodone versus doxepin as a pharmacologic sleep aid in psychiatric inpatients: A retrospective cohort study

Trazodone and doxepin are non-habit-forming options often used to treat insomnia in the psychiatric inpatient population. At our institution, trazodone 50 mg is the suggested initial treatment for insomnia included in the admission order set. The objective of this study was to determine if doxepin 25 mg is an effective alternative to trazodone 100 mg after the patient has failed treatment with trazodone 50 mg.

This retrospective cohort study included voluntary adult inpatients admitted to an academic medical center between July 2020 and June 2022 who received trazodone 100 mg or doxepin 25 mg after treatment failure with trazodone 50 mg for insomnia. The primary endpoint was treatment failure due to poor efficacy or tolerability. Secondary endpoints included changes in subjective sleep quality, subjective total sleep time, and estimates of objective total sleep time, time to sleep onset, wakefulness after sleep onset, and nighttime awakenings.

A total of 122 patients were included in the analysis. Treatment failure was noted in 35.2% of trazodone patients and 41.2% of doxepin patients (P = 0.58). There were no statistically significant differences in the secondary endpoints.

After treatment failure with trazodone 50 mg, there was no statistically significant difference in efficacy or tolerability between trazodone 100 mg and doxepin 25 mg for insomnia. A prospective trial would be necessary to directly compare the 2 treatment options.