I made the decision to maintain the patient’s current dosage of Trazodone at 50 mg, as it has already proven effective in improving his sleep quality. While priapism, an uncommon side effect in men, did occur, it eventually subsided, and no further adverse effects were reported. Instead of immediately switching to suvorexant 10 mg, I chose to continue with Trazodone because it has demonstrated the ability to alleviate the client’s insomnia, with priapism being the only drawback. Lowering the dosage to 25 mg at bedtime was not considered since studies have shown that 50 mg effectively addresses the client’s sleeplessness after just two weeks of use. Reducing the dose would not eliminate the occurrence of priapism, as it is a known side effect that diminishes over time (Vaesen & Sempels, 2023). Furthermore, zolpidem was not selected as an alternative due to the rare adverse effect of somnambulism or sleepwalking during the rapid eye movement (REM) phase of sleep, which can lead to injuries and cognitive impairments. It is crucial to avoid the risks associated with sleepwalking.
By maintaining the current medication regimen, my expectation was that the client’s priapism would gradually diminish, and his sleeplessness would be further alleviated. The goal was to strike a balance between addressing the adverse effects and providing effective treatment for insomnia. Considering the positive impact Trazodone had on sleep quality, it seemed reasonable to manage the side effect rather than abruptly switching to a different medication. Monitoring the client’s progress and addressing any concerns promptly would be essential in this case.
The ethical consideration arises regarding whether it is appropriate to encourage the client to continue taking a medication that has caused an undesired side effect. However, as of now, the client has not experienced any adverse effects that would necessitate a dosage reduction. By fully informing the client about the normalcy of these adverse effects and assuring them that they will subside over the course of treatment, achieving compliance can be possible through proper education. The decision to continue with Trazodone hinges on providing the client with all the necessary information, ensuring their understanding, and addressing any concerns they may have.
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