1. Introduction
Trazodone is an atypical antidepressant that functions as a serotonin antagonist and reuptake inhibitor (SARI). It is primarily used for major depressive disorder (MDD) and insomnia but also has off-label uses in anxiety disorders and PTSD.
2. Indications
- Major Depressive Disorder (MDD)
- Insomnia (Off-Label Use)
- Generalised Anxiety Disorder (GAD) (Off-Label Use)
- Post-Traumatic Stress Disorder (PTSD) (Off-Label Use)
- Agitation in Dementia (Off-Label Use)
3. Dosage
Adults:
- Depression:
- Start with 50–100 mg daily, increasing by 50 mg every 3–7 days.
- Maintenance dose: 150–300 mg daily (divided into 2–3 doses).
- Max dose: 600 mg/day (inpatients), 400 mg/day (outpatients).
- Insomnia (Off-Label Use):
- 25–100 mg at bedtime.
- Anxiety Disorders / PTSD:
- 50–150 mg/day, titrating as needed.
Elderly (>65 years):
- Start at a lower dose (25–50 mg/day) due to increased sedation risk.
Renal Impairment:
- No major adjustments required, but use with caution in severe kidney disease.
Hepatic Impairment:
- Use cautiously due to hepatic metabolism.
4. Administration
- Take with food to improve absorption and reduce dizziness.
- For sleep disorders, take at bedtime.
- Do not crush extended-release tablets; swallow whole.
5. Forms Available
- Immediate-Release Tablets: 50 mg, 100 mg, 150 mg, 300 mg
- Extended-Release Tablets: 150 mg, 300 mg
6. Side Effects
6.1 Common Side Effects:
- Drowsiness
- Dizziness
- Dry mouth
- Fatigue
- Headache
6.2 Less Common Side Effects:
- Nausea
- Constipation
- Blurred vision
6.3 Rare but Serious Side Effects:
- Priapism (prolonged painful erection, medical emergency)
- Orthostatic hypotension (risk of falls, especially in elderly patients)
- QT prolongation (cardiac arrhythmia risk)
- Serotonin Syndrome (if combined with SSRIs, MAOIs, or triptans)
7. Warnings
- Sedation Risk: Causes significant drowsiness; avoid alcohol and CNS depressants.
- Hypotension Risk: Can cause orthostatic hypotension, leading to dizziness or fainting.
- Risk of Priapism: Seek immediate medical attention for erections lasting >4 hours.
- QT Prolongation: Avoid in patients with arrhythmias or taking QT-prolonging drugs.
- Suicide Risk: Monitor mood changes and suicidal thoughts in young adults.
8. Precautions
- Avoid in severe liver disease due to hepatic metabolism.
- Caution in elderly patients due to increased sedation and fall risk.
- Monitor patients with heart disease, as trazodone can cause arrhythmias.
9. Interactions
- CNS Depressants (e.g., benzodiazepines, alcohol): Increased drowsiness and sedation.
- SSRIs & SNRIs (e.g., fluoxetine, venlafaxine): Increased risk of serotonin syndrome.
- QT-Prolonging Drugs (e.g., amiodarone, moxifloxacin): Increased risk of torsades de pointes.
- CYP3A4 Inhibitors (e.g., ketoconazole, ritonavir): Increased trazodone levels, increasing side effects.
- Antihypertensives (e.g., beta-blockers, ACE inhibitors): Enhanced hypotensive effects.
10. Monitoring Parameters
- Suicidal thoughts and mood changes in early treatment.
- Blood pressure (risk of hypotension and falls).
- ECG if high risk of QT prolongation.
- Watch for signs of serotonin syndrome (confusion, agitation, sweating, tremors).
11. Use in Children
- Not commonly used in children due to lack of sufficient safety data.
12. Use in Pregnancy
- Category C:
- Use only if benefits outweigh risks.
- May cause withdrawal symptoms in newborns if used late in pregnancy.
13. Use in Elderly
- Start with lower doses (25–50 mg/day) to prevent falls and excessive sedation.
- Increased risk of hyponatraemia and orthostatic hypotension.
14. Use in Kidney Disease
- No significant dose adjustment required, but monitor for accumulation in severe renal disease.
15. Use in Liver Disease
- Use cautiously, as trazodone is extensively metabolised in the liver.
- Avoid in severe hepatic impairment.
16. Patient Counselling Points
- Take with food to improve absorption and reduce dizziness.
- Do not drive or operate machinery until you know how it affects you.
- Avoid alcohol due to additive sedative effects.
- Report prolonged erections (>4 hours) immediately.
- Rise slowly from sitting or lying positions to prevent dizziness.
17. Table of Brand Names, Manufacturer, and Prices in USD
Brand Name | Manufacturer | Strength/Dosage Form | Price (USD) |
---|---|---|---|
Desyrel | Various | 50 mg, 100 mg Tablets | $40 (30 tablets) |
Trittico | Angelini | 150 mg, 300 mg Tablets | $60 (30 tablets) |
Generic Trazodone | Various | 50 mg, 100 mg Tablets | $20 (30 tablets) |
18. 15 FAQs (Frequently Asked Questions)
1. What is Trazodone used for?
It is used for depression, insomnia, and anxiety disorders.
2. How does Trazodone work?
It blocks serotonin reuptake and acts as a serotonin antagonist, improving mood and sleep.
3. How long does Trazodone take to work?
- For depression: 2–4 weeks.
- For sleep: Within 30–60 minutes.
4. Can I take Trazodone for sleep?
Yes, it is commonly used off-label for insomnia.
5. Does Trazodone cause weight gain?
Weight gain is less common than with other antidepressants.
6. Can I drink alcohol while taking Trazodone?
No, alcohol increases drowsiness and dizziness.
7. Can Trazodone cause erectile dysfunction?
No, but it can cause priapism (prolonged erections), which is a medical emergency.
8. Can Trazodone cause withdrawal symptoms?
Yes, stopping suddenly may cause nausea, agitation, dizziness.
9. Can Trazodone make me feel more depressed?
In some patients, it may initially worsen depression or suicidal thoughts.
10. Can I take Trazodone with SSRIs?
Caution is needed due to the risk of serotonin syndrome.
11. Does Trazodone cause nightmares?
Vivid dreams or nightmares are possible but uncommon.
12. Can I take Trazodone with blood pressure medications?
Yes, but monitor blood pressure, as trazodone can cause hypotension.
13. Is Trazodone safe for long-term use?
Yes, but requires regular monitoring for side effects.
14. Can I cut my Trazodone tablet in half?
Immediate-release tablets can be split; extended-release tablets should not be split.
15. How should Trazodone be stored?
Store at room temperature, away from moisture and heat.