Trazodone
Trazodone is an antidepressant. While generally safe to use, there are some risks...especially with long-term use.
Caution Still Recommended
Low Abuse Potential
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Uses
What Is Trazodone?
Trazodone is an antidepressant medication that belongs to the serotonin antagonist and reuptake inhibitor (SARI) class. It works by increasing the levels of serotonin, a neurotransmitter that helps regulate mood, in the brain. This medication is typically prescribed to treat major depressive disorder and is known for its sedative properties, which can also help with sleep disturbances.
What Is Trazodone Used For?
Trazodone is primarily used to treat major depressive disorder, but it is also prescribed off-label for other conditions such as anxiety, insomnia, and chronic pain. Its ability to improve mood, appetite, and energy levels makes it a versatile option for managing various symptoms associated with depression and anxiety. Additionally, its sedative effects are beneficial for patients experiencing sleep issues related to these conditions.
Trazodone Brand Names
Desyrel
Desyrel Dividose
Oleptro (Trazodone D)
Trazodone Side Effects
Trazodone, like any medication, can cause a range of side effects. Understanding these potential effects can help patients and healthcare providers manage and mitigate any adverse reactions. Below are the common and severe side effects associated with trazodone, as well as information on withdrawal symptoms and its impact on weight.
Common Side Effects
Drowsiness
Dizziness
Dry mouth
Blurred vision
Constipation
Nausea
Headache
Severe Side Effects
Irregular heartbeat
Shortness of breath
Severe dizziness or fainting
Swelling of the face, lips, or tongue
Persistent vomiting
Seizures
Unusual bleeding or bruising
Trazodone Withdrawal
Trazodone withdrawal can occur if the medication is abruptly discontinued. Symptoms may include anxiety, agitation, dizziness, headache, and nausea. It’s important to taper off trazodone under the guidance of a healthcare provider to minimize withdrawal effects and ensure a safe discontinuation process.
Does Trazodone Cause Weight Gain?
Trazodone can cause weight changes in some individuals, though it is not commonly associated with significant weight gain. Some patients may experience weight loss or a decrease in appetite, while others might notice a slight increase in weight. Monitoring weight and discussing any concerns with a healthcare provider can help manage this potential side effect.
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Warnings
Allergic Reactions
You should not use trazodone if you are allergic to it or if you are being treated with methylene blue injection. Allergic reactions can be severe and require immediate medical attention.
MAO Inhibitors
Do not use trazodone if you have taken an MAO inhibitor in the past 14 days. A dangerous drug interaction could occur. MAO inhibitors include isocarboxazid, linezolid, phenelzine, and tranylcypromine. Always inform your healthcare provider about any MAO inhibitors you have used.
Suicidal Thoughts
Some young people may experience thoughts of suicide when first taking an antidepressant like trazodone. Your doctor will need to monitor your progress regularly. Family members or caregivers should also be vigilant for any changes in mood or behavior.
Mood and Behavior Changes
Report any new or worsening symptoms to your doctor, such as mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or self-harm.
Use in Children
Do not give trazodone to anyone younger than 18 years old without the advice of a doctor. Trazodone is not approved for use in children and should be used with caution in this age group.
Before Taking
Do not take trazodone if you’re allergic to it, or if you have used an MAO inhibitor in the past two weeks to avoid dangerous interactions. To ensure safe use, inform your doctor if you’re taking the following:
Stimulants
Opioids
Herbal remedies
Other antidepressants
Also be transparent with your doctor if you’re taking other medications for depression or a separate mental illness, Parkinson’s disease, migraines, severe infections, or antiemetics (nausea and vomiting).
Lastly, tell your doctor is you have ever suffered from:
Liver or kidney conditions
Cardiac issues, including recent heart attacks
Blood clotting or bleeding disorders
Epilepsy or seizure disorders
Narrow-angle glaucoma
Long QT syndrome
Substance abuse or suicidal ideation
Bipolar disorder (manic depression)
Pregnancy Considerations
There is limited data on the safety of trazodone in pregnant women, and its effects on the developing fetus are not fully understood. Pregnant women should discuss all potential risks and benefits with their healthcare provider to make an informed decision. Additionally, if trazodone is used during pregnancy, close monitoring by a healthcare professional is recommended to ensure the health and safety of both the mother and the baby.
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Dosages
Initial Dosage for Depression (Adults)
For adults starting trazodone for depression, the initial dosage typically begins at 150 mg per day, divided into multiple doses. This starting dose helps to minimize potential side effects and allows the body to adjust to the medication.
Adult Dosage for Insomnia (Off-Label)
When used off-label for insomnia, trazodone is typically prescribed at a lower dose, ranging from 25 mg to 100 mg taken before bedtime. This lower dosage helps to induce sleep without causing significant daytime drowsiness.
Dosage Adjustments
Depending on the patient’s response and tolerance, the dosage may be increased by 50 mg per day every three to four days. This gradual increase helps to achieve the desired therapeutic effect while monitoring for any adverse reactions.
Max Dose for Adults
The maximum dose of trazodone for adults varies depending on the treatment setting. For outpatients, the highest recommended dose is 400 mg per day, while inpatients, who may require more intensive treatment, can be prescribed up to 600 mg per day. It is crucial to follow a healthcare provider’s guidance to avoid potential side effects and ensure safe use.
How Long Does Trazodone Take to Work?
Trazodone’s onset of action depends on its use. When taken for insomnia, it typically induces drowsiness within 30 to 60 minutes. However, when used to treat depression, it may take 4 to 6 weeks to experience the full therapeutic effects. Food can delay its absorption, so taking it on an empty stomach may result in quicker onset.
How Long Does Trazodone Last?
The duration of trazodone’s effects can vary, but generally, its sedative effects last between 4 to 8 hours. This duration can be influenced by factors such as dosage, individual metabolism, and whether the medication is taken with food. For most users, trazodone provides a relatively short-term effect, making it suitable for managing sleep disturbances.
Trazodone Half-Life
Trazodone has a half-life ranging from 5 to 13 hours, meaning it takes this amount of time for the concentration of the drug in the bloodstream to reduce by half. This half-life can vary based on individual factors such as age, health, and metabolic rate. Understanding the half-life is important for managing dosing schedules and anticipating how long the drug stays active in the system.
Other Considerations
Screening for Bipolar Disorder
Before initiating treatment with trazodone, patients should be screened for a personal or family history of bipolar disorder, mania, or hypomania.
Monitoring for Withdrawal Symptoms
Monitoring for withdrawal symptoms is essential when discontinuing therapy to ensure patient safety and comfort.
Dosage Reduction
Once an adequate response is achieved, the dosage may be gradually reduced based on therapeutic response to maintain effectiveness while minimizing side effects.
Managing Drowsiness
If drowsiness occurs, administering a major portion of the daily dose at bedtime or reducing the dosage may be necessary to improve patient comfort and adherence.
Administration with Food
Trazodone should be taken shortly after a meal or light snack to enhance absorption and minimize gastrointestinal discomfort.
Dosage Adjustments & Older Adults
Dosage adjustments may also be necessary for individuals with certain medical conditions, such as liver or kidney impairment. Additionally, older adults may require lower doses to reduce the risk of side effects. Always consult a healthcare provider for personalized dosing recommendations.
Interactions
Food Interactions
While trazodone is not specifically linked to tyramine-related interactions, it is advisable to consume foods rich in tyramine, such as aged cheeses, cured meats, and fermented foods, in moderation to minimize potential risks. Additionally, taking trazodone shortly after a meal or light snack can enhance absorption and reduce gastrointestinal discomfort.
Trazodone and Alcohol
Combining trazodone with alcohol can increase the risk of side effects such as drowsiness, dizziness, and impaired motor skills. Alcohol can also exacerbate trazodone’s sedative effects, making it important to avoid alcohol consumption while taking this medication.
Serotonergic Medications
Trazodone can interact with other medications that increase serotonin levels, such as selective serotonin reuptake inhibitors (SSRIs) like Lexapro, Prozac, and Cymbalta. These interactions can increase the risk of serotonin syndrome, a potentially life-threatening condition characterized by symptoms such as agitation, hallucinations, and rapid heart rate.
Blood Thinners and NSAIDs
Medications that affect blood clotting, such as blood thinners (e.g., warfarin, Xarelto) and nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, can interact with trazodone. These interactions may increase the risk of bleeding, so it is important to use these medications cautiously and under medical supervision.
CNS Depressants
Combining trazodone with other central nervous system (CNS) depressants, such as benzodiazepines (e.g., Xanax) and opioids (e.g., hydrocodone), can enhance sedative effects and increase the risk of respiratory depression. It is crucial to use these combinations only under strict medical guidance.
Other Medications
Certain medications can alter the levels of trazodone in the bloodstream. For example, fluconazole can increase trazodone levels, while carbamazepine can decrease them. These interactions may necessitate dosage adjustments to maintain therapeutic efficacy and minimize side effects.
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Overdose Potential
Trazodone overdose can occur, particularly when taken in large amounts or combined with other central nervous system depressants such as alcohol, barbiturates, or sedatives.
Symptoms of a trazodone overdose may include extreme drowsiness, vomiting, prolonged and painful erections, irregular or rapid heartbeat, seizures, and respiratory distress. In severe cases, an overdose can lead to coma or even be fatal. It is crucial to seek immediate medical attention if an overdose is suspected.
To minimize the risk of overdose, it is important to follow the prescribed dosage and avoid combining trazodone with other substances that can enhance its sedative effects.
Addiction Treatment
Is Trazodone Addictive?
Trazodone is not considered highly addictive in the traditional sense, but it can lead to physical dependence and psychological addiction if misused. Unlike narcotics or controlled substances, trazodone has a low potential for abuse, which is why it is not classified as a controlled substance by the FDA.
However, long-term use or misuse, such as taking higher doses than prescribed or using it without a prescription, can result in dependence. Symptoms of dependence may include withdrawal effects like insomnia, anxiety, and mood changes when discontinuing the medication. Knowing this, it’s important to use trazodone strictly as directed by a healthcare provider to minimize the risk of dependence and ensure safe use.
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FAQ
Frequently Asked Questions
Trazodone is an antidepressant medication primarily used to treat major depressive disorder. It works by increasing the levels of serotonin, a neurotransmitter that helps regulate mood, sleep, and anxiety. By restoring the balance of serotonin in the brain, trazodone can improve mood, appetite, and energy levels, while also reducing anxiety and insomnia associated with depression.
Trazodone is not classified as a narcotic. Narcotics, or opioids, are drugs that relieve pain by blocking pain receptors in the brain. Trazodone, on the other hand, is an antidepressant that alters brain chemicals to help ease depression and is sometimes used off-label to treat insomnia due to its sedative properties.
Trazodone is not a controlled substance. The U.S. Food and Drug Administration (FDA) does not classify it as such because it has a low potential for abuse and dependence. Unlike controlled substances, which are regulated due to their potential for addiction, trazodone is considered safe for use under medical supervision without the same risk of misuse.
Trazodone can cause sexual side effects, although these are less common compared to other antidepressants. Some individuals may experience changes in libido, with reports of both increased and decreased sex drive. Men may encounter issues such as ejaculation problems or prolonged erections, while women might notice changes in lubrication and breast size. These side effects are generally rare but should be discussed with a healthcare provider if they occur.
The minimum effective dose of trazodone for sleep typically ranges from 25 mg to 100 mg taken before bedtime. This lower dosage is often sufficient to induce sleep without causing significant daytime drowsiness. It is important to follow a healthcare provider’s recommendations to determine the appropriate dose based on individual needs and response to the medication.
If trazodone is not effectively helping with sleep, several factors could be at play. The dosage might be insufficient, or there could be underlying medical conditions or lifestyle factors interfering with its efficacy. Additionally, individual variations in metabolism and response to the medication can affect its effectiveness. Consulting a healthcare provider can help identify the cause and adjust the treatment plan accordingly.