1. What is trazodone?
Trazodone is an antidepressant that is used to treat major depressive disorder in adults. It is also used to treat anxiety, insomnia, panic attacks, and – in some cases – can form part of treatment for alcohol or substance dependency.
It is taken by mouth and is only available in the form of tablets, in strengths ranging from 50 mg to 300 mg. Tablets can be either regular-release or extended-release.
Trazodone is considered an atypical antidepressant as it is chemically different from the typical classes of antidepressants (SSRIs, TCAs, MAO inhibitors, and SNRIs). Rather, it is considered a serotonin antagonist and reuptake inhibitor (SARI) and primarily acts on serotonin receptors in the brain. The precise mechanisms of trazodone are not fully understood.
Trazodone is sold in the US under the brand names Desyrel, Desyrel Dividose, Oleptro, and Trazodone D. It is available under a wide range of other brand names throughout the world, such as Trazorel in Canada and Molipaxin in the UK and Ireland.
2. What is trazodone used for?
The only FDA-approved use for trazodone is treating major depressive disorder.
SSRIs – including sertraline, citalopram, fluoxetine, and escitalopram – are usually the first drugs used to treat major depressive disorder. Trazodone may be used in patients who are unable to tolerate these drugs or who experience side effects.
3. Can trazodone be used to help sleep?
Because trazodone has a sedative effect, it may also be used in patients who live with insomnia.
Insomnia is one of the common ‘off-label’ uses for trazodone. Off-label use of drugs means it is used in a manner that is not approved by the FDA and is done so at a physician’s discretion based on their professional opinion. Older drugs, such as trazodone, are regularly used in this manner as their effects are well-understood within the healthcare profession (and possibly approved in other countries).
Trazodone is usually used in low doses when used to treat insomnia.
Other off-label uses, often in combination with another form of medication, include:
- Symptoms of drug and alcohol withdrawal (primarily insomnia)
In these cases, your doctor will use his or her professional judgment in deciding whether trazodone may be beneficial in your treatment plan.
4. Can trazodone be used to treat pain?
Trazodone is not a painkiller but may be prescribed off-label to help people living with chronic pain (fibromyalgia) sleep better. Although trazodone does not reduce pain severity, there is evidence that the improvement in sleep can subsequently help reduce depression and anxiety, as well as helping reduce the interference pain has on patients’ daily activities.
5. How does trazodone work?
The mechanisms of trazodone are not fully understood.
Serotonin has long been believed to influence mood and low levels have been associated with depression. The majority of antidepressants work by preventing the reuptake of serotonin by receptors in the brain, thus increasing the availability of serotonin. Different types of antidepressants act on different receptors.
Trazodone is believed to primarily inhibit 5-HT2A receptors and, at higher doses, 5-HT2C receptors. This is largely believed to be the main reason for trazodone’s antidepressant effects and why it is prescribed at higher doses when treating major depressive disorder.
At lower doses, the effects on the 5-HT2A receptors, along with antihistaminic effects and alpha-adrenergic blocking, are believed to cause the sedative effects. That is why it is prescribed at lower doses when treating insomnia.
6. Does trazodone cause suicidal thoughts and behavior?
Trazodone comes with an FDA black box warning about suicidal thoughts and behavior. Black box warnings are the strictest warnings issued by the FDA and are done so when there is significant evidence that a drug or product is associated with an adverse reaction that may lead to death or serious injury.
The full black box warning regarding suicidal thoughts and behaviors reads:
Antidepressants increased the risk compared to placebo of suicidal thinking and behavior (suicidality) in children, adolescents, and young adults in short-term studies of major depressive disorder (MDD) and other psychiatric disorders.
Anyone considering the use of trazodone hydrochloride tablets or any other antidepressant in a child, adolescent, or young adult must balance this risk with the clinical need. Short-term studies did not show an increase in the risk of suicidality with antidepressants compared to placebo in adults beyond age 24; there was a reduction in risk with antidepressants compared to placebo in adults aged 65 and older.
Depression and certain other psychiatric disorders are themselves associated with increases in the risk of suicide. Patients of all ages who are started on antidepressant therapy should be monitored appropriately and observed closely for clinical worsening, suicidality, or unusual changes in behavior.
Families and caregivers should be advised of the need for close observation and communication with the prescriber. Trazodone hydrochloride tablets are not approved for use in pediatric patients.
7. What are the side effects of trazodone?
Trazodone can cause side effects, including:
- Bad taste in your mouth
- Dry mouth
- Blurred vision
- Dizziness, faintness, or lightheadedness
- Muscle aches and pains
- Weight loss
You should speak to your doctor if any of these side effects are severe, persistent, or worsen.
Serious side effects include:
- Fast, slow, or irregular heartbeat
- Chest pain
- Shortness of breath
- Unusual bruising or bleeding
- In men, a painful or long-lasting (4+ hours) erection (priapism)
- Thoughts of self-harm or suicide (see question 6: Does trazodone cause suicidal thoughts and behavior?)
Should any of these side effects occur, you should seek urgent medical attention.
Allergic reactions to trazodone are rare but can occur. Signs of a serious allergic reaction should be treated as a medical emergency. They include:
- Skin rash – for example itchy, red, or swollen skin
- Tightness in the chest or throat
- Trouble breathing or talking
- Swollen mouth, face, lips, tongue, or throat
This is not an extensive list of possible side effects of trazodone. For more information about side effects, please read the information leaflet that comes with the medication or speak to your doctor or pharmacist.
8. What is the correct dosage of trazodone?
For the treatment of major depressive disorder, the FDA recommends a starting dose of 150 mg/day, which may be increased by 50 mg/day every three or four days. A limit of 400 mg/day is recommended for outpatients and 600 mg/day for inpatients (more severe cases).
Trazodone may be taken once per day or every eight to 12 hours, depending on the dosage.
Dosage of trazodone for off-label treatments is usually lower than it is for major depressive disorder. For example, a doctor may prescribe 25 to 100 mg of trazodone for insomnia, taken once per day before bed.
9. Does trazodone cause weight gain?
Trazodone has been linked to both weight gain and weight loss.
As is the case with other antidepressants, it is not well understood why trazodone affects weight. It is possible that antidepressants slow your metabolism, which can cause weight gain. It is also possible that trazodone could interact with other medications and amplify side effects, one of which may be weight gain.
It is also theorized that weight gain (or loss) could be linked to the treatment of depression and its symptoms. For example:
- Appetite: Some people lack appetite when living with depression. Treating depression could increase appetite and lead to weight gain
- Enjoyment of food: Not enjoying food is a possible symptom of depression. Enjoying food again could lead to overeating and weight gain
- Sedative effect: The sedative effect of trazodone could lead to a more sedentary lifestyle, which can cause weight gain
- Social life: Treating depression may lead to people being more socially active, which may involve eating unhealthy food and drinking alcohol
The above lifestyle factors may be the reverse for some people. For example, treating depression may cause some people to have more energy and do more exercise, helping them lose weight. This could explain inconsistencies in research findings.
Ultimately, it is believed that a combination of factors determines how trazodone affects weight, many of which vary from person-to-person. Some people may gain weight, others may lose weight, and others may maintain their weight.
If you do experience weight gain while taking trazodone, it is advised that you continue to take your medications as prescribed and speak to your doctor.
10. Which other medications interact with trazodone?
There are many different drugs that can interact with trazodone.
One of the most serious interactions can cause a potentially life-threatening condition called serotonin syndrome, symptoms of which can include hallucinations, inducing a coma, tachycardia, seizures, and diarrhea. A number of drugs and supplements can interact with trazodone and increase your risk of serotonin syndrome, including:
- Other antidepressants, including SSRIs (such as citalopram), SNRIs (such as duloxetine), tricyclics (such as amitriptyline) and MAOIs (such as rasagiline)
- Tripants (such as sumatriptan, used to treat migraine headaches)
- Drugs containing dextromethorphan (found in many over the counter cough and cold medications)
- St. John’s wort
This is not a comprehensive list of substances that can interact with trazodone and increase your risk of serotonin syndrome.
Other possible interactions include:
- Selegiline and levodopa (both used to treat Parkinson’s disease)
- Warfarin or other blood thinners
- Carbamazepine, phenytoin, and other antiseizure medications (anticonvulsants)
- Ketoconazole and other antifungal medications
- Indinavir and other HIV medications
- Erythromycin, azithromycin and other macrolide antibiotics
Trazodone can interact with many more drugs and supplements than those listed here, some of which can increase the risk of serotonin syndrome. You should speak to your doctor about all prescription and over the counter medications you take, as well as supplements.
11. Can I drink alcohol while taking trazodone?
Alcohol is not thought to directly interact with trazodone. However, it may exacerbate side effects such as drowsiness, dizziness, and inability to concentrate. It is usually recommended that you avoid alcohol while taking trazodone.
12. Can I take trazodone when pregnant or breastfeeding?
Animal studies have found that very high doses of trazodone can be harmful to developing fetuses. However, there are no adequate and well-controlled studies about trazodone’s effect on pregnancy in humans. Accordingly, the FDA classes trazodone as ‘category C’ regarding pregnancy, meaning it should only be taken by pregnant women if absolutely necessary and if the benefits outweigh the potential risk to the fetus. Otherwise, alternative treatment should be considered.
This mirrors the advice offered by the NHS in the UK.
Similarly, animal studies suggest that trazodone may pass into breast milk in small amounts. It is recommended that caution is exercised regarding the use of trazodone in nursing mothers and that the health of the baby should be carefully monitored by a healthcare professional for any signs of abnormalities.
If you are pregnant or planning to have a baby, it is recommended that you continue taking your medication as prescribed and speak to your doctor about the safest course of action.
13. Will I suffer trazodone withdrawal when I stop taking it?
Although it is not addictive, your body does adjust to trazodone and you may experience withdrawal symptoms if you stop taking it. This is more likely if you have been taking trazodone for a long time and if you stop suddenly rather than slowly reducing the dosage.
Withdrawal symptoms can include anxiety, irritability, nausea, restlessness, and trouble sleeping, among others.
You should take trazodone as prescribed by your doctor. If you wish to stop taking the medication or change your treatment, you should always discuss the safest way of doing so with your doctor in order to mitigate the risk of withdrawal symptoms.
14. Does trazodone get you high?
Trazodone is not a narcotic and does not produce a euphoric ‘high’.
Likewise, trazodone is not considered addictive. However, it is possible to become dependent on trazodone, especially if you have taken it for a long time. When this occurs, the withdrawal symptoms discussed in the previous question can occur when you stop taking the medication.
If you have concerns about addiction or substance abuse, either regarding yourself or someone you know, we urge you to seek the appropriate medical help or treatment.
The content on this page is provided for informational purposes only. If you have any questions or concerns about your treatment, you should talk to your doctor, pharmacist, or healthcare professional. This is particularly important if you are taking multiple medications or have any existing medical conditions.
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