Effectiveness of high-dose clonazepam versus low-dose clonazepam with cognitive behavioral therapy in older adults with moderately severe insomnia: a prospective cohort study

•Low-dose clonazepam combined with CBT-i had early improvement in ISI and SUDS scores than high-dose clonazepam.•The frequency of adverse drug reactions was higher in high-dose clonazepam than low-dose clonazepam with CBT-i.•For individuals who were resistant to 0.5 mg of clonazepam, adding CBT-i is...

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Published in:Clinical therapeutics 2024-01, Vol.46 (1), p.69-73
Main Authors: Sankar, Karthik, Shanmugasundram, Natrajan, Baskaran, Balaswetha, Anabalagan, Deepika, Sivaraman, Varadharajan, Santhiyagu, Xavier, Rajanandh, Muhasaparur Ganesan
Format: Article
Language:English
Subjects:
Adults
Aged
Anesthesia
Anxiety
Behavior modification
Benzodiazepines
Caffeine
Chronic Disease
Chronic illnesses
Clonazepam
Clonazepam - adverse effects
Cognitive ability
Cognitive Behavioral Therapy
Cognitive therapy
Cohort analysis
Drug dosages
Drug therapy
Effectiveness
Ethics
Exercise
Humans
Hygiene
Insomnia
older adults
Older people
Physical fitness
Prospective Studies
Side effects
Sleep
Sleep disorders
Sleep Initiation and Maintenance Disorders - drug therapy
Statistical analysis
Treatment Outcome
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Summary:•Low-dose clonazepam combined with CBT-i had early improvement in ISI and SUDS scores than high-dose clonazepam.•The frequency of adverse drug reactions was higher in high-dose clonazepam than low-dose clonazepam with CBT-i.•For individuals who were resistant to 0.5 mg of clonazepam, adding CBT-i is a viable option to increasing the dose to 1 mg. To evaluate the effectiveness of high-dose clonazepam (1 mg) versus low-dose clonazepam (0.5 mg) with cognitive behavioral therapy for insomnia (CBT-i) in older adults with moderately severe insomnia. A prospective cohort study was conducted in patients who did not respond to low-dose clonazepam for insomnia secondary to chronic medical conditions. After starting with 0.25 mg of clonazepam, their dose was increased to 0.5 mg, then to 1 mg (Group A), or to the same dose with additional CBT-i (Group B). They were followed for 24 weeks, and scores of the insomnia severity index (ISI) and subjective units of distress scale (SUDS) were recorded. Patient adverse drug reactions (ADRs) were documented and assessed for their causality. ISI and SUDS scores were considered primary outcome measures. Between-group analysis revealed a significant decline in the mean score of ISI at week 16 (p
ISSN:0149-2918
1879-114X
DOI:10.1016/j.clinthera.2023.10.010