Dr. Seikhoo Bishnui
Psychiatry
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
I have been taking 100 mg Trazadone and 2 mg Klonopin for many years for sleep issues. However, my previous doctor retired, and my new doctor wants me to discontinue both these drugs and put me on Dayvigo or Belsomra. Both of these drugs seem new to the market to me. Do you prefer Trazadone with additional Klonopin versus switching to Dayvigo or Belsomra?
Hello,
Welcome to icliniq.com.
Trazodone and Klonopin are both good drugs for insomnia. However, Klonopin carries a risk of tolerance, and I think this is the probable reason the new doctor wants to change medicines. But if you were sleeping good with these drugs, I do not think that it is a good idea to change medicines.
Yes, Belsomra and Dayvigo are both very new drugs, but they have been shown promising efficacy in insomnia and have no risk of tolerance. If switched properly after tapering the dose of Klonopin, I think this will be helpful to you in the long term.
But if you consider my suggestion, I will follow the old rule not to change the prescription if there is no problem with sleep.
Thank you.
Patient's Query
Hello doctor,
Thank you for the reply.
Trazadone and Klonopin work well for sleep. However, most doctors outside of major US cities are hesitant to use a stable dose of Klonopin. My doctor from Boston says studies have been debunked about the hazard of long-term Klonopin use, and this new nurse I saw today does not like Klonopin and wants me to change to Belsomra. I consulted with my doctor in Boston (close to retiring), and she said Klonopin at a low dose helps with anxiety and even acts as a mood stabilizer. Do you have thoughts on a low dose, long-term use of Klonopin?
Hello,
Welcome back to icliniq.com.
I have seen a few of my patients who are just taking 0.5 to 1 mg doses for 7 to 8 years, and they are doing good. It not only helps in sleep but also helps in controlling anxiety. So yes, it has mood-stabilizing actions (proven in some studies).
Apart from the risk of tolerance, Klonopin has no serious side effects. Trazodone too is very safe drug and has no metabolic side effects so can be used even long term without worries.
You can discuss this with your current doctor again and raise your concerns. However, if there is no ongoing problem, I do not see any benefit in changing to new drugs from old stable prescriptions.
Thank you.
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Psychiatry
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