Trazodone

Trazodone is approved by the FDA as a prescription drug used for the medical treatment of depression. In addition to depression, this drug may also be prescribed by a doctor or mental health professional as a treatment for insomnia, and may also be used to treat anxiety and panic attacks. 

• Trazodone is available under the following different brand names: Desyrel, Desyrel Dividose, Oleptro, Trazodone D.

Common side effects of Trazodone include:

• drowsiness, 
• dizziness, 
• tiredness, 
• swelling, 
• weight loss, 
• blurred vision, 
• diarrhea, 
• constipation, and 
• stuffy nose

Serious side effects of Trazodone include:

• hives, 
• difficulty breathing, 
• swelling in the face, lips, tongue, or throat, 
• penis erection that is painful or lasts 6 hours or longer, 
• mood or behavior changes, 
• anxiety, 
• panic attacks, 
• trouble sleeping, 
• impulsive behavior, 
• irritableness, 
• agitation, 
• hostility, 
• aggression, 
• restlessness, 
• hyperactivity (mentally or physically), 
• increased depression, 
• thoughts of self-harm, 
• fast or pounding heartbeats, 
• fluttering in the chest, 
• shortness of breath, 
• sudden dizziness, 
• slow heartbeats, 
• unusual thoughts or behavior, 
• easy bruising, 
• unusual bleeding, 
• headache, 
• confusion, 
• slurred speech, 
• severe weakness, 
• vomiting, 
• loss of coordination, 
• feeling unsteady, 
• hallucinations, 
• fever, 
• sweating, 
• shivering, 
• muscle stiffness, and
• twitching

Rare side effects of Trazodone include:

• none 

Seek medical care or call 911 at once if you have the following serious side effects:

• Severe headache, confusion, slurred speech, arm or leg weakness, trouble walking, loss of coordination, feeling unsteady, very stiff muscles, high fever, profuse sweating, or tremors;
• Serious eye symptoms such as sudden vision loss, blurred vision, tunnel vision, eye pain or swelling, or seeing halos around lights;
• Serious heart symptoms such as fast, irregular, or pounding heartbeats; fluttering in your chest; shortness of breath; sudden dizziness, lightheartedness, or passing out.

Adult dosage

Tablet

• 50 mg
• 100 mg
• 150 mg
• 300 mg

Tablet, extended-release

• 150 mg
• 300 mg

Depression

Adult dosage

• Initial 150 mg/day orally divided every 8-12 hours
• Increase by 50 mg/day every 3-7 days
• Outpatient: No more than 400 mg/day
• Inpatient: No more than 600 mg/day

Oleptro (extended-release)

• 150 mg orally at bed-time initially; may increase by increments of 75 mg/day every 3 days; not to exceed 375 mg/day
• Swallow whole or may break in half along the scored line; do not chew or crush

Pediatric Depression Treatment (Off-label)

• 6-12 years: 1.5-2 mg/kg/day orally in divided doses initially; not to exceed 6 mg/kg/day divided every 8 hours
• Over 12 years: 25-50 mg/day orally; increase by 100-150 mg in divided doses

Geriatric Depression Treatment

• Immediate release: 25-50 mg orally at bedtime; increase the dose by 25-50 mg every three days if inpatient or every week if outpatient not to exceed 75-150 mg/day
• Extended-release: Experience limited; use 150 mg orally at bedtime initially; may increase by increments of 75 mg/day every 3 days; not to exceed 375 mg/day

Insomnia (Off-label)

• 50-100 mg orally once per day.

Aggressive Behavior (Off-label)

• Initial: 50 mg orally every 12 hours.
• Maintenance: 75-400 mg/day divided orally every 6-12 hours

Cocaine Withdrawal (Off-label)

• 150-200 mg orally once per day.

Alcohol Withdrawal (Off-label)

• 100-600 mg/day divided orally

Insomnia (Off-label)

• 25-100 mg orally at bedtime.

Prevention of Migraine (Off-label)

• 100 mg orally once per day.

Dose Considerations

• Monoamine oxidase inhibitors: Do not administer trazodone within 14 days of administering monoamine oxidase inhibitors when treating a psychiatric disorder
• Co-administration with monoamine oxidase inhibitors linezolid or IV methylene blue
• This drug is not recommended in patients actively receiving linezolid or IV methylene blue
• Consider other interventions if treating psychiatric diseases or conditions such as schizophrenia
• If coadministration is necessary, because benefits outweigh dangers, monitor for serotonin syndrome for 2 weeks or until 24 hours after the last dose of linezolid or IV methylene blue, whichever comes first; may resume medication 24 hours after the last dose of linezolid or IV methylene blue

Administration

• Take with food

If your medical doctor is using this medicine to treat your pain, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them.  Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider, or pharmacist first

• Trazodone has severe interactions with at least 17 other drugs.
• Trazodone has serious interactions with at least 124 other drugs.
• Trazodone has moderate interactions with at least 415 other drugs.
• Trazodone has minor interactions with at least 137 other drugs.

This information does not contain all possible interactions or adverse effects. Visit the RxList Drug Interaction Checker for any drug interactions. Therefore, before using this drug, tell your doctor or pharmacist about all the drugs you use. Keep a list of all your medications with you, and share the list with your doctor and pharmacist. Check with your physician if you have health questions or concerns.

Warnings

• In short-term studies, antidepressants increased the probability of problems such as suicidal thinking and behavior in children, adolescents, and young adults (under 24 years of age) taking antidepressants to treat major depressive disorders and other psychiatric diseases and conditions
• This increase was not seen in patients aged older than 24 years; a slight decrease in suicidal thinking was seen in adults older than 65 years
• In children and young adults, possible dangerous outcomes must be weighed against the health benefits of taking antidepressants
• Patients should be monitored closely for changes in behavior, clinical worsening of depression symptoms or mental health, and suicidal tendencies; this should be done during initial 1-2 months of therapy and dosage adjustments
• The patient's family should communicate any abrupt changes in behavior or health to the doctor or healthcare provider
• Worsening behavior, worsening depression symptoms and problems, and suicidal tendencies that are not part of the presenting symptoms may require discontinuation of therapy
• This drug is not FDA approved for use in pediatric patients or for treatment of bipolar depression with or without episodes of anxiety
• This medication contains trazodone Do not take Desyrel, Desyrel Dividose, Oleptro, or Trazodone D if you are allergic to trazodone or any ingredients contained in this drug
• Keep out of reach of children. In case of overdose, get medical help or contact a Poison Control Center immediately

Contraindications

• Hypersensitivity

Coadministration with serotonergic drugs

• Risk of serotonin syndrome when coadministered within 14 days of MAOIs, or coadministered with other strong serotonergic drugs (eg, SNRIs, SSRIs)
• Starting trazodone in a patient who is being treated with linezolid or IV methylene blue is contraindicated because of an increased risk of serotonin syndrome
• If linezolid or IV methylene blue must be administered, discontinue trazodone immediately and monitor for CNS toxicity; may resume clomipramine 24 hours after the last linezolid or methylene blue dose or after 2 weeks of monitoring, whichever comes first

Effects of drug abuse

• None

Short-Term Effects

• See “What Are Side Effects Associated with Using Trazodone?”

Long-Term Effects

• See “What Are Side Effects Associated with Using Trazodone?”

Cautions

• Administer shortly after a meal; if drowsiness occurs, decrease the dosage or give most of the divided dosage HS
• Discontinue if prolonged or inappropriate erection occurs
• Discontinue if neutropenia, leukopenia
• Use caution in patients with a risk of seizures
• Clinical worsening and suicide ideation may occur despite medication in adolescents and young adults (18-24 years)
• Perform leukocyte and differential with fever, sore throat, or other signs of infection
• Discontinue if leukocytes/ANC decreases below the normal range
• Coadministration with MAO inhibitors: risk of serotonin syndrome
• Drugs that interfere with serotonin reuptake have been associated with bleeding; trazodone may also impair platelet aggregation resulting in an increased risk of bleeding events
• Potentially life-threatening serotonin syndrome is reported when coadministered with drugs that impair serotonin metabolism (in particular, MAOIs, including non-psychiatric MAOIs, such as linezolid and IV methylene blue) (see Contraindications)
• Coadministration with NSAIDs and aspirin may increase the risk of bleeding
• Bone fractures associated with antidepressant treatments
• Increases risk of hyponatremia
• Use caution in patients with a risk of seizures including head trauma, alcoholism, brain damage
• May worsen psychosis in patients or precipitate mania or hypomania; screen, for bipolar disorder, patients presenting with depressive symptoms
• May cause orthostatic hypotension and syncope; use with caution
• QT prolongation with or without torsade de pointes and ventricular tachycardia reported
• May increase risk associated with electroconvulsive therapy (ECT); discontinue ECT before initiating trazodone therapy
• The risk of mydriasis; may trigger angle closure attack in patients with angle-closure glaucoma with anatomically narrow angles without a patent iridectomy

Pregnancy and Lactation

• Published prospective cohort studies, case series, and case reports over several decades with use in pregnant women have not identified drug-associated risks of major birth defects, miscarriage, or adverse maternal or fetal outcomes
• The drug has been shown to cause increased fetal resorption and other adverse effects on fetuses in rats when given at dose levels of approximately 7.3 to 11 times the maximum recommended human dose (MRHD) of 400 mg/day in adults on an mg/m² basis; there was also an increase in congenital anomalies in the rabbit at approximately 7.3 to 22 times the MRHD on an mg/m² basis
• Consider the risk of untreated depression when discontinuing or changing treatment with antidepressant medication during pregnancy and postpartum
• Data from published literature report the transfer of trazodone into human milk; there are no data on the effect on milk production; limited data from post-marketing reports have not identified an association of adverse effects on the breastfed child
• The developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for therapy and any potential adverse effects on the breastfed child or from the underlying maternal condition