Fall risk with trazodone versus zolpidem for the treatment of insomnia in the elderly

Introduction:

Zolpidem and trazodone are the two most commonly prescribed medications for insomnia, and the prevalence of insomnia increases with age to more than 50% in the elderly. Use of either zolpidem or trazodone in the elderly is the associated adverse effects that put patients at risk for falls and subsequent injury.  Currently, there is limited data demonstrating the efficacy of zolpidem and trazodone for the treatment of insomnia in the elderly, yet there is more evidence for adverse effects that increase the risk of falls.

Objectives:

Primary objective: to determine if there is a difference in fall risk with trazodone compared to zolpidem for the treatment of insomnia in elderly patients in the ambulatory setting. Secondary objective: to determine if there is a difference in efficacy with trazodone compared to zolpidem for the treatment of insomnia in the elderly.

Study Design:

This single-center, IRB-approved, survey study aims to evaluate 160 ambulatory patients, aged 65 years and older, with a diagnosis of insomnia who received either zolpidem or trazodone. 

Methods:

Patients with a diagnosis of depression or Parkinson’s disease or with prescriptions for benzodiazepines, antidepressants, or other medications for insomnia will be excluded.  Patients meeting eligibility criteria will be contacted via telephone and asked scripted questions regarding falls, near-falls, and efficacy of insomnia treatment over the preceding 12 months. 

Results:

Thus far, data collection is complete for a total of 42 patients. Of these, 26% have experienced a fall/near fall (N=8 for zolpidem, and N=3 for trazodone). Additionally, patients on zolpidem have reported a better quality of sleep compared with trazodone.

Conclusions:

Currently, zolpidem has been associated with more falls/near falls than trazodone. Continued data collection is on-going.