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Dr. Phil, MD
Dr. Phil, MD, Board Certified Physician
Category: Medical
Satisfied Customers: 54817
Experience:  GP in the United States
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Hello I have previously asked how I could switch from amitryptiline

Resolved Question:

Hello
I have previously asked how I could switch from amitryptiline to another medication for insomnia control. Amitryptiline causes me erectile dysfunction (I've had bllod tests and no organic problems have been found).

Over the past year, I have been on a sleep restriction programme - largely limiting myself to 5 hrs 10 mins to 6 hrs in bed per night. I have been mostly consistent over 15 months on the programme, waking between 7-9 am each day over that time: usually 7.30-8am.

Result: I have reduced my dosage from 100 mg to 20 mg per night. (I actually cut it to 25 mg in the first 5-6 months, since when afootball injury meant months of no exercise, worsened sleep, a temporary higher dose, followed by cutting back to 25 mg and withdrawals: it cost me 4-5 months top get back to where i was prior to the injury).

Now, I am struggling on the 20 mg dose (two months on it), but usually get 5 hrs sleep, and it is far deeper than I previously slept and so compensates in part for the short sleep period. It feels like i get 6hrs plus of sleep - not great, but often ok.

If I switch to trazadone (question 1: do you agree that's the best option? induce sleep without causing impotence), question 2 and MAIN question: what dose should I aim for that is consistent with 20 mg of amitryptiline for insomnia rather than depression control?
Submitted: 3 years ago.
Category: Medical
Expert:  Dr. Phil, MD replied 3 years ago.

Dr. Phil, MD :

Hello. I'm Dr. Phil, licensed and practicing internist. Excellent service is my goal.

Dr. Phil, MD :

please enter chat

Customer:

hello

Dr. Phil, MD :

Hi I'm Dr. Phil

Dr. Phil, MD :

Can I ask your first name?

Customer:

You have my question?

Customer:

Robert

Dr. Phil, MD :

Yes, I do

Dr. Phil, MD :

I totally agree with trazodone

Dr. Phil, MD :

And number 2 I agree with 20-25 mg of amitryptiline

Customer:

I believe you were among the two who previously recommended it. I was thinking about dosage considering my current 20 mg of amitryptiline

Dr. Phil, MD :

I would go with 25 mg

Customer:

I am already on 20 mg of amitryptiline. The question is: if i switch to trazadone, what would the equivalent dosage be for trazdone ot aid sleep?

Customer:

25 mg of trazadone, you mean?

Dr. Phil, MD :

50 mg traz

Dr. Phil, MD :

25 amitry

Customer:

I am only asking about traz. I am already on amitryptiline for a long time, and want to get off it. So you are saying 50 mg traz equals 20 mg amitryptiline WHEN used as a sleep aid?

Dr. Phil, MD :

no 50 mg traz is 25 mg of amitr

Customer:

OK, so 50 mg traz is a bit higher than 20 amit. i guess from that that 40 mg (if that is possible) would equal 20 0f amit? Simply, amit is double the strength of traz. Are tablet form available that one could cut?

Dr. Phil, MD :

I think traz only comes in 50 mg doses

Dr. Phil, MD :

you can cut them for sure

Dr. Phil, MD :

if needed

Dr. Phil, MD :

amit comes in 10,25,50

Customer:

ok. Thank you. You previously mentioned that traz can cause the opposite effect on erections. What precautions if any should i take with it?

Dr. Phil, MD :

no precautions at a 50 mg dose

Dr. Phil, MD :

but an erection lasting > 4 hours is a medical emergency

Customer:

OK. so if that last thing happens, i would have to stop. Is it very rare?

Dr. Phil, MD :

it is VERY rare at 50 mg dose

Dr. Phil, MD :

I have never seen it

Customer:

OK. I'd be very unlucky then, especially considering amit experience. Thanks again

Dr. Phil, MD :

you're welcome

Dr. Phil, MD :

did I do excellent for you today?

Customer:

Proof is in the pillpudding. But that has made my mind up for me. I'll rate you high. thanks

Dr. Phil, MD :

LOL

Dr. Phil, MD :

thank you sir

Dr. Phil, MD :

good luck!

Dr. Phil, MD, Board Certified Physician
Category: Medical
Satisfied Customers: 54817
Experience: GP in the United States
Dr. Phil, MD and 2 other Medical Specialists are ready to help you

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