TRAZODONE

brands

Class

• Neuroscience-based Nomenclature: serotonin receptor antagonist (S-MM)
• SARI (serotonin 2 antagonist/reuptake inhibitor); antidepressant; hypnotic

TRAZODONE commonly prescribed for

(Bold for FDA approved)

How TRAZODONE works

• Blocks serotonin 2A receptors potently

• Blocks serotonin reuptake pump (serotonin transporter) less potently

How long until TRAZODONE works

• Onset of therapeutic actions in insomnia is immediate if dosing is correct

• Onset of therapeutic actions in depression usually not immediate, but often delayed 2–4 weeks whether given as an adjunct to another antidepressant or as a monotherapy

• If it is not working within 6–8 weeks for depression, it may require a dosage increase or it may not work at all

• May continue to work for many years to prevent relapse of symptoms in depression and to reduce symptoms of chronic insomnia

Notable Side Effects

• Nausea, vomiting, edema, blurred vision, constipation, dry mouth

• Dizziness, sedation, fatigue, headache, incoordination, tremor

• Hypotension, syncope

• Occasional sinus bradycardia (long-term)

• Rare rash

Life Threatening Side Effects

• Rare priapism

• Rare seizures

• Rare induction of mania

• Rare activation of suicidal ideation and behavior (suicidality) (short-term studies did not show an increase in the risk of suicidality with antidepressants compared to placebo beyond age 24)

weight gain

unusual

sedation

common

What to do about TRAZODONE side effects

• Wait

• Wait

• Wait

• Take larger dose at night to prevent daytime sedation

• Switch to another agent

usual dosage range

• 150–600 mg/day

Dosage Forms

• Tablet 50 mg scored, 100 mg scored, 150 mg, 150 mg with povidone scored, 300 mg with povidone scored

long term use

• Safe

habit forming

• No

Renal Impairment

• No dose adjustment necessary

Hepatic Impairment

• Drug should be used with caution

Cardiac Impairment

• Trazodone may be arrhythmogenic

• Monitor patients closely

• Not recommended for use during recovery from myocardial infarction

Elderly

• Elderly patients may be more sensitive to adverse effects and may require lower doses

• Reduction in the risk of suicidality with antidepressants compared to placebo in adults age 65 and older

Children and Adolescents

• Carefully weigh the risks and benefits of pharmacological treatment against the risks and benefits of nontreatment with antidepressants and make sure to document this in the patient’s chart

• Monitor patients face-to-face regularly, particularly during the first several weeks of treatment

• Use with caution, observing for activation of known or unknown bipolar disorder and/ or suicidal ideation, and inform parents or guardians of this risk so they can help observe child or adolescent patients

• Safety and efficacy have not been established, but trazodone has been used for behavioral disturbances, depression, and night terrors

• Children require lower initial dose and slow titration

• Boys may be even more sensitive to having prolonged erections than adult men

Pregnancy

• Effective June 30, 2015, the FDA requires changes to the content and format of pregnancy and lactation information in prescription drug labels, including the elimination of the pregnancy letter categories; the Pregnancy and Lactation Labeling Rule (PLLR or final rule) applies only to prescription drugs and will be phased in gradually for drugs approved on or after June 30, 2001

• Controlled studies have not been conducted in pregnant women

• Avoid use during first trimester

• Must weigh the risk of treatment (first trimester fetal development, third trimester newborn delivery) to the child against the risk of no treatment (recurrence of depression, maternal health, infant bonding) to the mother and child

• For many patients this may mean continuing treatment during pregnancy

• National Pregnancy Registry for Antidepressants: 1-866-961-2388, https://womensmentalhealth.org/research/ pregnancyregistry/antidepressants

Breast Feeding

• Some drug is found in mother’s breast milk

• If child becomes irritable or sedated, breast feeding or drug may need to be discontinued

• Immediate postpartum period is a high-risk time for depression, especially in women who have had prior depressive episodes, so drug may need to be reinstituted late in the third trimester or shortly after childbirth to prevent a recurrence during the postpartum period

• Must weigh benefits of breast feeding with risks and benefits of antidepressant treatment versus nontreatment to both the infant and the mother

• For many patients, this may mean continuing treatment during breast feeding