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Wednesday, July 23, 2025

Trazodone


Generic Name

Brand Names
Generic formulations available worldwide

Drug Class
Serotonin antagonist and reuptake inhibitor (SARI)
Sedative-hypnotic (off-label)


Mechanism of Action
Trazodone functions through a dual mechanism
It inhibits serotonin reuptake (5-HT reuptake) by presynaptic neurons
This dual serotonergic effect leads to increased serotonin availability and modulation of receptor overstimulation
At low doses, its antihistaminergic (H1) and alpha-1 adrenergic antagonist effects dominate, causing sedation and hypotension
Minimal anticholinergic effects
No significant inhibition of norepinephrine or dopamine reuptake


Indications

Approved Uses
Major depressive disorder (MDD) in adults

Off-Label Uses
Insomnia (commonly prescribed in low doses)
Post-traumatic stress disorder (PTSD)
Obsessive-compulsive disorder (OCD)
Schizophrenia (as adjunct)


Dosage and Administration

Major Depression (Adults)
Initial dose 150 mg/day in divided doses
Increase by 50 mg every 3 to 4 days
Maximum dose outpatient 400 mg/day
Maximum dose inpatient 600 mg/day

Extended-release (Oleptro)
Initial 150 mg once daily at bedtime
Can be increased by 75 mg every 3 days
Maximum dose 375 mg/day

Insomnia (Off-label use)
Common dose 25–100 mg once daily at bedtime
Sedative effects are prominent at lower doses

Geriatric Population
Start at lower doses (e.g. 25–50 mg/day) due to fall risk and sedation
Titrate slowly based on tolerability

Pediatric Use
Not approved for use in children under 18
Rarely used and only under psychiatric supervision

Use with caution
Lower initial doses and slower titration advised
Monitor for accumulation

Administration
Immediate-release tablets usually given after meals or snacks
Extended-release formulations should be swallowed whole and not crushed


Pharmacokinetics
Absorption
Well absorbed orally
Bioavailability 65–80%
Food increases absorption
Distribution
Extensively bound to plasma proteins (~90–95%)
Widely distributed in body tissues
Metabolism
Hepatic metabolism via CYP3A4
Major active metabolite: m-chlorophenylpiperazine (mCPP)
Elimination
Excreted via urine (~70%) and feces (~20%)
Elimination half-life ~5 to 13 hours (dose-dependent)
Biphasic with longer half-life in elderly or liver dysfunction


Contraindications
Known hypersensitivity to trazodone or its components
Concurrent use with MAO inhibitors or within 14 days of MAOI discontinuation
Initiation during recovery phase of myocardial infarction
Caution with use in patients at risk for QT prolongation


Warnings and Precautions

Suicidality
Increased risk of suicidal thoughts and behavior in adolescents and young adults
Monitor closely during initiation and dosage changes

Dose-dependent risk
Monitor ECG in patients with cardiac disease or electrolyte abnormalities
Avoid with other QT-prolonging drugs

Sedation and CNS Depression
May impair mental and physical abilities
Caution with driving or operating machinery

Orthostatic Hypotension
Due to alpha-1 adrenergic antagonism
Common in elderly and at higher doses

Priapism
Rare but serious adverse effect
Prolonged erections require emergency treatment
May necessitate discontinuation

Serotonin Syndrome
Possible when combined with other serotonergic agents
Symptoms include agitation, confusion, fever, tremor, hyperreflexia
Discontinue if suspected

Hepatotoxicity
Rare reports of liver enzyme elevations and hepatic failure
Monitor liver function tests if clinically indicated


Adverse Effects

Very Common
Sedation
Drowsiness
Dizziness
Dry mouth
Fatigue

Common
Headache
Nausea
Blurred vision
Constipation
Hypotension
Weight changes
Sweating

Less Common
Arrhythmias
Tachycardia
Confusion
Mania
Agitation
Tremor
Urinary retention

Rare but Serious
QT prolongation
Torsades de pointes
Priapism
Hepatitis
Hyponatremia
Seizures
Suicidal ideation


Overdose

Symptoms
Extreme sedation
Respiratory depression
Arrhythmias
Hypotension
Seizures
Coma

Management
Supportive care
Monitor cardiac and respiratory function
Activated charcoal if within 1–2 hours
No specific antidote
ECG monitoring required


Drug Interactions

Pharmacodynamic Interactions
MAO inhibitors → serotonin syndrome risk
SSRIs SNRIs triptans tramadol → additive serotonergic effects
Alcohol CNS depressants → enhanced sedation
Antihypertensives → increased hypotension risk
Anticholinergics → additive effects on cognition and dry mouth

Pharmacokinetic Interactions
CYP3A4 inhibitors (ketoconazole, ritonavir, erythromycin) → increased trazodone levels
CYP3A4 inducers (carbamazepine, phenytoin, rifampin) → decreased trazodone levels
Digoxin and phenytoin → may increase serum levels of both
Warfarin → increased INR monitoring recommended


Use in Special Populations

Pregnancy
Category C
Use only if benefits outweigh risks
Animal studies show adverse fetal effects
Human data limited
Monitor for withdrawal symptoms in neonates if used late in pregnancy

Lactation
Excreted in small amounts in breast milk
Consider risk-benefit; limited data

Geriatrics
Greater risk of falls and orthostatic hypotension
Start at lower doses
Monitor for sedation and cardiovascular effects

Renal/Hepatic Impairment
Start with lower doses
Use cautiously and monitor for accumulation


Monitoring Parameters
Mental status and mood changes
Blood pressure (especially orthostatic)
Signs of serotonin syndrome
ECG in high-risk populations
Suicidal ideation
Liver function (if symptoms develop)
Priapism or genital complaints


Comparative Pharmacology

Compared to SSRIs
Less sexual dysfunction
More sedating
More cardiovascular side effects
Used when SSRIs are poorly tolerated

Compared to mirtazapine
Both are sedating but mirtazapine has more appetite stimulation
Trazodone may be preferred if weight gain is undesirable

Compared to benzodiazepines for insomnia
Trazodone lacks dependency potential
Safer in patients with history of substance use

Compared to TCAs
Less anticholinergic effects
Lower seizure risk
Less cardiotoxic in overdose


Formulations Available
Tablets: 50 mg, 100 mg, 150 mg, 300 mg
Extended-release (Oleptro): 150 mg, 300 mg (withdrawn in some markets)
Available generically in most countries


Regulatory and Legal Status
Prescription-only medication
Approved by FDA for depression
Widely used off-label for insomnia
Not classified as a controlled substance
Included in many national formularies



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