Trazodone

(traz-uh-doan)

Trade/other name(s): Desyrel, trazodone hydrochloride, Oleptro

Why would this drug be used?

Trazodone is a type of antidepressant. It is used to help treat depression, but doctors may prescribe it for some types of pain or for other reasons as well.

How does this drug work?

Trazodone seems to work by raising levels of a key chemical in the brain called serotonin.

Before taking this medicine

Tell your doctor…

• If you are allergic to anything, including medicines, dyes, additives, or foods.
• If you have ever thought about or attempted suicide. Treatment with an antidepressant may raise the risk of suicidal thoughts, especially during the first few months of treatment.
• If you drink alcohol or are taking any type of sedative (drug that makes you feel calm or drowsy). Trazodone could possibly increase their effects on the nervous system, which in some cases could be dangerous.
• If you have recently had a heart attack, have any kind of heart disease or abnormal heart rhythms, including prolonged QT interval. This drug may raise the risk of heart problems including irregular heart rhythms.
• If you take any blood pressure medicines or have ever fainted. This drug may lower your blood pressure, which could be dangerous if it is already affected by other medicines.
• If you have low potassium, sodium, or magnesium levels, or if you are taking medicines such as diuretics (“water pills”) that may affect levels of those minerals. These problems can affect the heart’s electrical system, and this drug can make it worse.
• If you have kidney disease or liver disease (including hepatitis or cirrhosis). This drug is cleared from the body by these organs. Reduced kidney or liver function may result in more drug than expected staying in the body. This could lead to unwanted side effects. Your doctor will want to monitor you closely and may need to adjust your dose accordingly.
• If you have bipolar disorder (manic depressive illness). This drug could possibly make this condition worse by increasing the risk of going into a manic phase.
• If you have taken monoamine oxidase inhibitors (MAOIs, such as isocarboxazid, phenelzine, selegiline, and tranylcypromine) within the past 2 weeks (see “Interactions with other drugs”).
• If you have any other medical conditions such as lung disease, congestive heart failure, diabetes, gout, or infections. You may need closer monitoring of these conditions while being treated.
• If you are planning on having surgery in the near future. Your doctor may want to stop trazodone before surgery to avoid possible drug interactions with the anesthetic drugs.
• If you are pregnant, trying to get pregnant, or if there is any chance of pregnancy. This drug might cause problems if either the male or female is taking it at the time of conception or during pregnancy. It is important to check with your doctor about whether birth control should be used with this medicine. This drug should be used during pregnancy only if clearly needed.
• If you are breast-feeding. This drug passes into breast milk and may affect the baby. Talk with your doctor about the possible risks of breast-feeding while taking this drug.
• About any other prescription or over-the-counter medicines you are taking, including vitamins and herbs. In fact, keeping a written list of each of these medicines (including the doses of each and when you take them) with you in case of emergency may help prevent complications if you get sick.

Interactions with other drugs

Trazodone may interact with several other drugs.

Tryptophan and St. John’s wort (dietary supplements) are not recommended while taking this drug.

Trazodone should not be taken with the anti-fungal drugs itraconazole or ketoconazole. They can cause trazodone to build up to high levels in the blood and cause serious effects.

This drug can increase your risk of bleeding. Using aspirin, aspirin-containing medicines, non-steroidal pain drugs (such as ibuprofen or naproxen), warfarin (Coumadin), dabigatran (Pradaxa), rivaroxaban (Xarelto), or other blood thinners, including any type of heparin injections, can further increase this risk.

Because of the way this drug is processed by the liver, trazodone levels in the body may be affected by a number of other drugs or supplements. These include:

• Antidepressant drugs such as nefazodone (Serzone) or fluvoxamine (Luvox)
• Antibiotics clarithromycin and erythromycin
• Cimetidine (Tagamet), a drug that reduces stomach acid
• HIV drugs such as ritonavir, indinavir, or nelfinavir
• Blood pressure medicines such as diltiazem and verapamil

Certain medicines, supplements, and other substances can reduce the amount of trazodone in the body, so that it does not work as well:

• Anti-seizure medicines such as carbamazepine (Tegretol), phenobarbital, phenytoin (Dilantin)
• Pioglitazone (Actos), for diabetes
• Tuberculosis medicines rifampin and rifabutin
• Smoking cigarettes

Other medicines may also have this effect. If you need one of these medicines while you are taking trazodone, your doctor may need to adjust your trazodone dose.

Trazodone may raise the levels of digoxin or phenytoin in the body, so your doctor may need to change your doses of these drugs.

This drug should be used with caution in people who are taking any type of blood pressure medicine, because it can cause sudden drops in blood pressure when sitting or standing, which can result in fainting.

Trazodone can add to the effects of other medicines or substances that make you sleepy or less alert, such as:

• Antihistamines
• Tranquilizers (sedatives)
• Sleeping pills
• Muscle relaxers
• Barbiturates
• Anti-seizure medicines
• Opioid pain medicines
• Anesthetics
• Antidepressants such as amitriptyline, desipramine, doxepin, imipramine, nortriptyline
• Anti-psychotic drugs
• Certain anti-nausea medicines
• Alcohol

Antidepressants known as monoamine oxidase inhibitors (MAOIs) such as phenelzine (Nardil), tranylcypromine (Parnate), isocarboxazid (Marplan), or selegiline (Emsam) may raise the risk of serious side effects (such as increased blood pressure or body temperature, seizures, coma, or even death) and should not be taken within 2 weeks of taking trazodone. The antibiotic linezolid (Zyvox) and the dye methylene blue, which are both given in the vein, also act as MAOIs and interact in a harmful way with this drug.

There may be other interactions not listed above. Check with your doctor, nurse, or pharmacist about all of your medicines, herbs, and supplements.

Interactions with foods

Alcohol could have more potent effects on the nervous system while taking trazodone. Its use should be avoided while taking this drug.

Grapefruit or grapefruit juice may change the level of this drug in your body. This could affect how well the drug works or whether or not you have side effects.

No other serious interactions with foods are known at this time. Check with your doctor, nurse, or pharmacist about whether some other foods may be a problem.

Tell all the doctors, dentists, nurses, and pharmacists you visit that you are taking this drug.

How is this drug taken or given?

Trazodone is taken by mouth as a tablet, 2 to 3 times a day. It should be taken shortly after a meal or light snack. If trazodone makes you very sleepy, check with your doctor to see if you can take most of your daily dose at bedtime.

The extended-release form of trazodone (Oleptro) is taken in the late evening on an empty stomach. Do not crush or chew the pills. They can be broken along the score line if your doctor or nurse instructs you to do so.

The dose may depend on a number of factors, including your kidney and liver function and how well you respond to the drug. Trazodone is usually started at a fairly small daily dose. If needed, this may be increased after 3 to 4 days. Lower doses may be recommended in people with kidney or liver problems.

For some people this medicine may take several weeks to start working. Do not change the dose or stop taking this drug without first speaking to your doctor or nurse. If you are going to stop taking this drug, you should do so gradually over the course of several weeks, as directed by your doctor. This drug may stay in your body for some time after the last dose is taken. Talk to your doctor before starting any new medicines.

Store the medicine in a tightly closed container and away from children or pets.

Precautions

This drug can interact with several other medicines and should be used cautiously in people with a number of different medical conditions. See the “Before taking this medicine” and the “Interactions with other drugs” sections of this document for more detailed information.

This drug may make you feel drowsy when you first start taking it or if the dose is increased. It may also affect your thinking, judgment, and coordination (ability to walk and move about). Do not drive or operate heavy machinery until you know how the drug affects you. Use caution if taking cold or allergy medicines, sedatives, anxiety medicines, or sleeping pills while taking this medicine. Alcohol use is not recommended. Talk to your doctor or nurse if you feel too drowsy or it does not go away.

This drug may cause a quick drop in blood pressure when you go from lying down to sitting up, or from sitting to standing up (postural hypotension). This may cause you to feel dizzy or faint if you sit up or stand up too quickly, which can cause falls or injuries. Changing position slowly can reduce the risk of these problems. Let your doctor know if this happens to you.

Men may experience unwanted prolonged or even painful erections (priapism) while taking this drug. In some cases this may require medicine or even surgery to correct. Stop taking this medicine and tell your doctor or nurse right away if you have prolonged or unwanted erections.

Do not stop taking this medicine without consulting your doctor. Sudden stopping can cause anxiety, agitation, dizziness, vomiting, fatigue, and disturbed sleep.

In rare cases, this drug may affect your heart rhythm, which could be dangerous or even cause sudden death. If you have any type of heart disease, talk to your doctor about this.

Trazodone should be used with caution if you have bipolar disorder (manic depressive illness). This drug could make this condition worse.

As with other antidepressants, this drug may raise the risk of suicidal thoughts and actions, mostly in people under age 25. This is more common during the first few months of treatment. If you notice any strange or unusual thoughts or behavior, such as irritability, sleep problems, aggressiveness, restlessness, panic attacks, or thoughts of suicide while on this medicine, call your doctor. Tell family members, loved ones, and caregivers that you are taking this drug, so that they can help you if they notice behavior changes.

This drug can rarely cause a problem called serotonin syndrome, with symptoms such as nausea, vomiting, diarrhea, headache, restlessness, and confusion. It can also cause bleeding, easy bruising, and trouble walking. This syndrome can become life-threatening if not treated quickly, progressing to fever, rigid muscles, rapid changes in pulse and blood pressure, agitation, and coma. If you have symptoms like these, get help and call your doctor right away.

In very rare cases, this drug may cause a low white blood cell count, which could increase the risk of serious infections. Your doctor may check your white blood cell count during treatment. Be sure to let your doctor or nurse know right away if you have any signs of infection, such as fever (100.5^o or higher), chills, pain when passing urine, sore throat, a new cough, or bringing up sputum.

If you think that you or someone else may have taken an overdose of this medicine, get emergency help right away. Taking too much trazodone or taking it with alcohol or any other medicine that slows the nervous system can cause drowsiness, vomiting, seizures, and slowed or stopped breathing.

Possible side effects

You will probably not have most of the following side effects, but if you have any talk to your doctor or nurse. They can help you understand the side effects and cope with them.

Common

• Feeling drowsy*
• Dry mouth
• Feeling dizzy or lightheaded*

Less common

• Headache
• Nausea/vomiting
• Blurred vision
• Weight gain or loss
• Constipation
• Feeling tired or weak
• Muscle or joint pain
• Stuffy nose

Rare

• Trouble concentrating
• Drop in blood pressure when sitting or standing up quickly, which may make you feel dizzy or faint*
• Anxiety, agitation*
• Confusion*
• Trembling
• Unwanted or painful erections (men) *
• Trouble sleeping
• Poor judgment and coordination*
• Change in heart rhythm or faster heartbeat*
• Low white blood cell count*
• Suicidal thoughts or actions*
• Allergic reaction
• Death due to heart rhythm problems, serotonin syndrome, or neuroleptic malignant syndrome

*See the “Precautions” section for more detailed information.

There are other side effects not listed above that can also occur in some patients. Tell your doctor or nurse if you develop these or any other problems.

FDA approval

Yes – first approved prior to 1984. (FDA cannot verify dates of drugs approved before 1984.)

Disclaimer: This information does not cover all possible uses, actions, precautions, side effects, or interactions. It is not intended as medical advice, and should not be relied upon as a substitute for talking with your doctor, who is familiar with your medical needs.