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Trazodone

Class
Antidepressants
Subclass
5-HT receptor mixed agonist-antagonist
Substance name
traZODone hydrochloride
Common formulations
Tablet
Dosage and administration
Adults patients
Major depressive disorder
•
Start at: 150 mg PO daily, in divided doses
•
Maintenance: 150-400 mg PO daily, in divided doses
•
Maximum: 400 mg per day
Titrate in 50 mg/day increments every 3-4 days based on response and tolerance. Reduce dose gradually after achieving adequate response.
Insomnia in patients with Alzheimer's disease • Off-label
•
50 mg PO qHS
Insomnia in patients with PTSD • Off-label
•
50-200 mg PO qHS
Nightmares in patients with PTSD • Off-label
•
50-200 mg PO qHS
Other off-label uses
•
Treatment of generalized anxiety disorder
•
Treatment of insomnia in patients with Huntington's disease
•
Treatment of insomnia in patients with Parkinson's disease
•
Treatment of insomnia in patients with concussion
Indications for use
Labeled indications
Adults
•
Treatment of major depressive disorder
Off-label indications
Adults
•
Treatment of generalized anxiety disorder
•
Treatment of insomnia in patients with Alzheimer's disease
•
Treatment of insomnia in patients with Huntington's disease
•
Treatment of insomnia in patients with Parkinson's disease
•
Treatment of insomnia in patients with concussion
•
Treatment of insomnia in patients with PTSD
•
Treatment of nightmares in patients with PTSD
Safety risks
Boxed warnings
Suicidal ideation
•
Use extreme caution in patients with major depressive disorder or other psychiatric disorders, particularly in children, adolescents, and young adults.
Contraindications
Hypersensitivity to trazodone or its components
Myocardial infarction in the acute recovery phase
QT prolongation
•
Do not use trazodone in patients with known QT prolongation or those at risk of torsade de pointes and/or sudden death, including symptomatic bradycardia, hypokalemia, or hypomagnesemia.
Concomitant use of MAOIs
•
Do not use trazodone with or within 14 days of stopping MAOIs, including reversible MAOIs, such as linezolid and methylene blue.
Concomitant use of QT-prolonging agents
Warnings and precautions
Acute angle-closure glaucoma
•
Use caution in patients with untreated anatomically narrow angles.
Antidepressant discontinuation syndrome
•
Do not discontinue abruptly in patients taking the drug for a prolonged period.
Bleeding
•
Use caution in patients taking NSAIDs, aspirin, or other antiplatelet or anticoagulant agents.
Cardiac arrhythmias
•
Use caution in patients with preexisting cardiac disease. Obtain monitoring.
Manic or mixed episodes
•
Use caution in patients with bipolar disorder.
Orthostatic hypotension, syncope, decreased serum sodium
•
Maintain a high level of suspicion, as trazodone has been associated with an increased risk for these adverse events.
Priapism
•
Use caution in male patients with conditions predisposing them to priapism, such as sickle cell anemia, multiple myeloma, leukemia, angulation, cavernosal fibrosis, or Peyronie's disease.
Serotonin syndrome
•
Use caution in patients taking other serotoninergic drugs.
Somnolence, cognitive difficulties, motor impairment
•
Use extreme caution in patients performing activities requiring mental alertness, such as driving or operating machinery.
Specific populations
Renal impairment
CrCl 0-90 mL/min
•
Use with caution.
Renal replacement therapy
Continuous renal replacement
•
Use with caution.
Intermittent hemodialysis
•
Use with caution.
Peritoneal dialysis
•
Use with caution.
Hepatic impairment
Any severity
•
Use with caution.
Pregnancy and breastfeeding
Pregnancy
All trimesters
•
Consider safer alternatives. Evidence of fetal harm in animals.
Breastfeeding
Use only if benefits outweigh potential risks.
Unknown drug levels in breastfed infants.
No overt adverse effects reported in breastfed infants.
No overt adverse effects on lactation reported.
Adverse reactions
Very common > 10%
•
Blurred vision, dizziness, lightheadedness, dry mouth, headache, nausea, somnolence, vomiting
Common 1-10%
•
Bradycardia, hypertension, hypotension, abdominal pain, akathisia, back pain, chest pain, confusion, constipation, ↓ libido, diarrhea, difficulty concentrating, dysgeusia, dyspnea, erectile dysfunction, fatigue, nervousness, flatulence, hallucinations, delusions, hematuria, hostility, hypersalivation, ↑ appetite, ↑ libido, insomnia, loss of appetite, malaise, memory impairment, speech disturbance, menstrual irregularity, tachycardia, palpitations, myalgia, nasal congestion, nightmares, paresthesia, syncope, tinnitus, urinary frequency, urinary retention, urinary urgency, visual disturbances, weight gain, weight loss, retrograde ejaculation, tremor, VT
Uncommon < 1%
•
Acne vulgaris, agitation, gait disturbance, gastroesophageal reflux disease, photosensitivity of skin, hearing loss, hypoesthesia, night sweats, photophobia, skin flushing, dry eyes, eye pain, suprapubic pain, urinary incontinence, vertigo
Unknown frequency
•
Ataxia, cognitive impairment, ↓ serum sodium, hemolytic anemia, ↑ WBC count, myoclonus, tics, jaundice, methemoglobinemia, ↑QT interval, mania, seizure, suicidal ideation, skin rash, suicidal ideation, syndrome of inappropriate antidiuretic hormone secretion, serotonin syndrome, priapism, tardive dyskinesia, torsade de pointes
Interactions
Drug(s)
Check Interactions
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