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Indications

Trazodone Hydrochloride is an antidepressant used to treat depression, including depression with anxiety or sleep problems. Doctors sometimes also use it for anxiety and for sleep difficulties linked to depression. It is a prescription medicine.

How It Works

Trazodone belongs to a group called serotonin antagonist and reuptake inhibitors (SARIs). It increases the amount of serotonin, a chemical messenger in the brain that affects mood, while blocking certain serotonin and histamine receptors. This combination helps lift mood and reduce anxiety, and also has a calming, sleep-promoting effect.

Dosage and Administration

Take exactly as prescribed. The doctor usually starts with a low dose and increases it gradually, depending on your response and side effects. It is usually taken after food, often as a single dose at bedtime or in divided doses. It may take 2 to 4 weeks to feel the full benefit. Do not stop suddenly; your doctor will lower the dose slowly when it is time to stop.

Interactions

• MAO inhibitors (such as Moclobemide or Linezolid): risk of serious reactions; do not combine.
• Other serotonin-raising medicines (such as Fluoxetine, Sertraline, Tramadol, triptans or St John's wort): risk of serotonin syndrome.
• Strong CYP3A4 inhibitors (such as Ketoconazole, Ritonavir or Clarithromycin) can raise Trazodone levels; Carbamazepine can lower them.
• Alcohol, sleeping tablets, opioid pain relievers and antihistamines that cause drowsiness add to sleepiness.
• Medicines that affect heart rhythm (QT prolongation), blood pressure medicines, Warfarin, Digoxin and Phenytoin may need extra monitoring.

Contraindications

• Allergy to Trazodone.
• Recovery period after a recent heart attack.
• Use of an MAO inhibitor within the last 14 days.
• Alcohol or sleeping tablet poisoning.

Side Effects

Common side effects include drowsiness, dizziness, dry mouth, headache, nausea, blurred vision, constipation and feeling light-headed on standing. Less often it may cause irregular heartbeat, low sodium (confusion, weakness), and in men a painful, long-lasting erection (priapism). In children and young adults, antidepressants can increase suicidal thoughts in the early weeks.

Get urgent medical help if you have an erection lasting more than 4 hours, fainting or a fast or irregular heartbeat, thoughts of harming yourself, high fever with stiffness, confusion and sweating (possible serotonin syndrome), or signs of a severe allergic reaction.

Pregnancy and Lactation

Safety in pregnancy is not fully established; use only if your doctor decides the benefit outweighs the risk, and do not stop suddenly without advice. Small amounts pass into breast milk; discuss with your doctor before breastfeeding.

Precautions and Warnings

• It can cause drowsiness: do not drive or operate machines until you know how it affects you.
• Avoid alcohol.
• Use with care in heart disease, epilepsy, liver or kidney disease, and in older people.
• Family members should watch for worsening mood or suicidal thoughts, especially when starting or changing the dose.

Overdose

Overdose may cause severe drowsiness, vomiting, low blood pressure, irregular heartbeat, seizures, breathing problems and priapism. It is more dangerous when taken with alcohol or other sedatives. Seek emergency medical help immediately.

Therapeutic Class

Antidepressant; serotonin antagonist and reuptake inhibitor (SARI).

Storage

Store below 30°C in a dry place, away from light, and out of the reach of children.