Trazodone

Brand Name(s): Desyrel, Desyrel Dividose, Oleptro, Trazodone D

Generic Name: trazodone

Drug Class: Antidepressants

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 by prescription only under the following different brand names: Desyrel, Desyrel Dividose, Oleptro, and Trazodone D.

Dosages of Trazodone

Tablets (pills)

• 50 mg
• 100 mg
• 150 mg
• 300 mg

Tablets, extended-release (pills)

• 150 mg
• 300 mg

Adult Depression Treatment

• 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 bedtime 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

Side effects of trazodone include:

• blurred vision
• dizziness
• drowsiness
• dry mouth
• fatigue
• headache or mild headache
• nausea/vomiting
• constipation
• swelling
• confusion
• disorientation
• lack of coordination
• nasal congestion
• feeling faint or dizzy when standing up
• fainting
• tremor
• weight change
• ejaculation disorder
• decreased libido
• painful erection
• sedation
• hair loss
• anxiety
• acne
• anemia
• increased appetite
• double vision
• insomnia
• urinary retention
• spinning sensation (vertigo)

This document does not contain all possible side effects and others may occur. Check with your physician for additional information about side effects.

If your doctor has directed you to use this medication, 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. Be sure to tell your doctor your personal or family history of bipolar disorder, personal or family history of suicide attempts, liver disease, heart disease, heart conditions, or if you have had a heart attack.

• Severe Interactions of Trazodone include:
  • arsenic trioxide
  • astemizole
  • cisapride
  • disopyramide
  • eliglustat
  • ibutilide
  • indapamide
  • isocarboxazid
  • pentamidine
  • phenelezine
  • pimozide
  • procainamide
  • saquinavir
  • sotalol
  • terfenadine
  • tranylcypromine
• Trazodone has serious interactions with at least 124 different drugs.
• Trazodone has moderate interactions with at least 415 different drugs.
• Trazodone has minor interactions with at least 137 different drugs.

This document does not contain all possible interactions. Therefore, before using this product, tell your doctor, health care professional, or pharmacist of all the products you use. Keep a list of all your medications with you, and share the list with your doctor and pharmacist. Check with your physician or medical professional if you have health questions, concerns, or problems.

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
• Co-administration with serotonergic drugs
  • Risk of serotonin syndrome when co-administered within 14 days of MAOIs, or co-administered with other strong serotonergic drugs (for example SNRIs, SSRIs)
  • Starting this medication in a patient who is being treated with linezolid or IV methylene blue is contraindicated because of the greater 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 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 also "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 at bedtime
• Discontinue if a prolonged or inappropriate erection occurs
• Discontinue if reduction of white blood cells
• Use caution in patients with risk of seizures
• Clinical worsening and suicide ideation may occur despite medication in adolescents and young adults (18-24 years).
• Perform white blood cell count and differential with fever, sore throat, or other signs or symptoms of infection
• Discontinue if white blood cells or absolute neutrophil count decreases below the normal range
• If co-administered 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 a greater risk of bleeding events
• Potentially life-threatening serotonin syndrome reported when co-administered with drugs that impair serotonin metabolism (in particular, MAOIs, including non-psychiatric MAOIs, such as linezolid and IV methylene blue)
• Co-administration with NSAIDs and aspirin may result in bleeding
• Bone fractures associated with antidepressant treatments
• May cause low sodium levels in your blood
• Use caution in patients who may have seizures including head trauma, alcoholism, and brain damage
• Patients should keep all appointments with their doctor and should read all literature that comes with the prescription
• May worsen psychosis in patients or precipitate mania or hypomania; screen, for bipolar disorder, patients presenting with depressive symptoms and signs
• May cause orthostatic low blood pressure and fainting; use with caution
• QT prolongation with or without torsade de pointes and ventricular rapid heart rate reported
• May increase risk associated with electroconvulsive therapy (ECT); discontinue ECT before initiating trazodone therapy
• Possible mydriasis; may trigger angle closure attack in patients with angle-closure glaucoma with anatomically narrow angles without a patent iridectomy

Pregnancy and Lactation

• Use trazodone with caution in pregnancy if benefits outweigh risks
• Animal studies show uncertainty and human studies are not available or neither animal nor humans studies are done
• Trazodone is excreted into breast milk
• Use caution and consult with your physician
• AAP states effect on nursing infants is unknown but may be of concern)