Trazodone: Restore Restful Sleep and Relieve Depression
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Synonyms | |||
Trazodone hydrochloride is a prescription medication belonging to the class of serotonin antagonist and reuptake inhibitors (SARIs). It is primarily indicated for the treatment of major depressive disorder (MDD) and is widely used off-label for the management of insomnia, particularly where sleep initiation and maintenance are problematic. Its unique pharmacological profile offers a dual mechanism, modulating serotonin activity to improve mood while promoting sedation, making it a versatile agent in psychiatric and sleep medicine. This product card provides a comprehensive, evidence-based overview for healthcare professionals.
Features
- Active ingredient: Trazodone hydrochloride
- Available in 50 mg, 100 mg, 150 mg, and 300 mg oral tablets
- Generic and brand-name formulations (e.g., Desyrel®)
- Serotonin antagonist and reuptake inhibitor (SARI) class
- Half-life: Approximately 5–9 hours for initial phase; 7–13 hours for secondary phase
- Metabolism: Hepatic, primarily via CYP3A4
- Excretion: Renal (70–75%) and fecal (20–25%)
Benefits
- Effectively alleviates symptoms of major depressive disorder, including low mood, anhedonia, and psychomotor retardation.
- Promotes improved sleep architecture by reducing sleep latency and decreasing nighttime awakenings.
- Lower risk of anticholinergic side effects compared to some tricyclic antidepressants.
- Generally well-tolerated with a favorable side effect profile when dosed appropriately.
- Non-habit forming and not classified as a controlled substance, reducing abuse potential.
- May be used adjunctively with other antidepressants to mitigate insomnia side effects.
Common use
Trazodone is FDA-approved for the treatment of major depressive disorder (MDD) in adults. It is also extensively used off-label for the management of chronic and acute insomnia, especially in patients with comorbid depression or anxiety. Its sedative properties make it particularly useful when sleep initiation is a primary concern. It may also be prescribed for anxiety disorders, fibromyalgia, and as an adjunct in the treatment of certain substance withdrawal syndromes, though these uses are not formally approved.
Dosage and direction
For depression: The initial adult dose is 150 mg per day in divided doses. The dose may be increased by 50 mg per day every three to four days. The maximum dose for outpatients is usually 400 mg per day in divided doses; inpatient doses may reach 600 mg per day under close supervision.
For insomnia (off-label): Dosing typically ranges from 25 mg to 100 mg taken once daily at bedtime. Doses as low as 25–50 mg are often effective for sleep induction and are associated with fewer side effects.
Trazodone should be taken shortly after a meal or light snack to reduce the incidence of dizziness or nausea. Tablets should be swallowed whole and not crushed or chewed.
Precautions
- Use with caution in patients with cardiovascular disease, as trazodone has been associated with orthostatic hypotension and, rarely, arrhythmias.
- Priapism (prolonged and painful erection) is a rare but serious side effect requiring immediate medical attention; male patients should be counseled on this risk.
- May cause sedation or impair cognitive and motor performance; patients should avoid driving or operating machinery until they know how the medication affects them.
- Suicidal ideation may occur, particularly in children, adolescents, and young adults; close monitoring is advised especially during initial treatment or dose changes.
- Use cautiously in patients with a history of seizures or hepatic/renal impairment; dosage adjustment may be necessary.
- Abrupt discontinuation may lead to withdrawal symptoms including anxiety, agitation, and sleep disturbances; taper gradually under medical supervision.
Contraindications
- Hypersensitivity to trazodone or any component of the formulation.
- Concurrent use with, or within 14 days of discontinuing, monoamine oxidase inhibitors (MAOIs) due to risk of serotonin syndrome.
- Patients in the acute recovery phase after myocardial infarction.
- Known history of priapism.
Possible side effect
Common side effects (≥1%):
- Drowsiness, sedation
- Dizziness, lightheadedness
- Headache
- Nausea, vomiting
- Dry mouth
- Blurred vision
- Constipation
- Fatigue
Less common but serious side effects:
- Priapism
- Serotonin syndrome (agitation, hallucinations, tachycardia, hyperthermia)
- Orthostatic hypotension
- Suicidal thoughts or behavior
- Arrhythmias
- Hyponatremia
- Extrapyramidal symptoms (rare)
Drug interaction
- MAOIs: Risk of serotonin syndrome; contraindicated.
- SSRIs/SNRIs (e.g., fluoxetine, sertraline): Increased risk of serotonin syndrome.
- CNS depressants (e.g., benzodiazepines, alcohol, opioids): Enhanced sedative effects.
- CYP3A4 inhibitors (e.g., ketoconazole, ritonavir): May increase trazodone levels and risk of adverse effects.
- CYP3A4 inducers (e.g., carbamazepine, rifampin): May decrease trazodone efficacy.
- Antihypertensives: May potentiate hypotensive effects.
- Warfarin: May alter anticoagulant effect; monitor INR.
- Digoxin, phenytoin: Trazodone may increase levels of these drugs.
Missed dose
If a dose is missed, it should be taken as soon as remembered unless it is almost time for the next dose. In that case, skip the missed dose and resume the regular dosing schedule. Do not double the dose to make up for a missed one.
Overdose
Symptoms of overdose may include severe drowsiness, vomiting, priapism, respiratory depression, seizures, and cardiac arrhythmias. Management is supportive and symptomatic; ensure airway protection and monitor vital signs. There is no specific antidote. Gastric lavage may be considered if presented early. Priapism requires urgent urological intervention. Contact a poison control center immediately.
Storage
Store at room temperature (20–25°C or 68–77°F), in a tightly closed container, away from light, moisture, and heat. Keep out of reach of children and pets. Do not use after the expiration date printed on the packaging.
Disclaimer
This information is intended for educational purposes and healthcare professionals. It is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or medication. Do not disregard professional medical advice or delay in seeking it because of something you have read here.
Reviews
“Trazodone has been a cornerstone in my practice for treating depression with comorbid insomnia. Its sedative properties are effective and generally well-tolerated at lower doses, though vigilance for side effects like orthostasis is necessary.” — Psychiatrist, 15 years experience.
“Using trazodone off-label for insomnia has provided significant benefit for many of my patients who cannot tolerate or have contraindications to other hypnotics. The low abuse potential is a major advantage.” — Sleep Medicine Specialist.
“While effective, I always caution male patients about the risk of priapism. It’s rare, but the consequences are serious. Appropriate patient selection and education are key.” — Urologist.