For sleep aid, patient with severe insomnia you dr. had to choose between prescribing amitriptyline or trazadone or flexeril, (cyclobenzaprine hcl) which one would you choose? and how would you monitor it?

Variable: I use trazodone frequently for insomnia since it is scored two different ways on the tablet. It gives a variety of doses to try from a 150 mg dose. In other words, you can try 50-75-100-125-1150 mg at bedtime for a sleep aid. Flexeril (cyclobenzaprine hcl) is also a reasonable attempt at sleep aid. I monitor by early morning feelings more than anything.

Adjunct,side effects: It all depends on the situation. The bigger question to me is "why does the patient have insomnia?" and then deal with that piece. You mentioned that you're on methotrexate, but not why. Similarly, you've had a cardiac catheterization, but don't state the reason. The choice of drug when treating insomnia, if a drug therapy is required at all, depends strongly on the other conditions.