Trazodone: Restore Restful Sleep and Mood Balance
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Synonyms | |||
Trazodone is an FDA-approved antidepressant medication belonging to the serotonin antagonist and reuptake inhibitor (SARI) class, widely prescribed for its dual efficacy in managing major depressive disorder and insomnia. Its unique pharmacological profile promotes serotonin activity while mitigating common activating side effects associated with traditional SSRIs, making it a versatile option in psychiatric and sleep medicine. Clinicians value trazodone for its favorable side effect profile, low abuse potential, and utility in both acute and maintenance therapy.
Features
- Active ingredient: Trazodone hydrochloride
- Available formulations: Oral tablets (50 mg, 100 mg, 150 mg, 300 mg)
- Mechanism of action: Serotonin antagonist and reuptake inhibitor (SARI)
- Half-life: Approximately 5–9 hours
- Bioavailability: High, with peak plasma concentrations within 1–2 hours post-administration
- Metabolism: Hepatic, primarily via CYP3A4
- Excretion: Renal (70–75%) and fecal (20–25%)
Benefits
- Promotes restorative sleep architecture by reducing sleep latency and increasing total sleep time
- Alleviates symptoms of depression through enhanced serotonergic neurotransmission
- Lower risk of sexual dysfunction compared to SSRIs and SNRIs
- Minimal potential for dependence or abuse, supporting long-term therapeutic use
- Off-label utility in anxiety disorders, fibromyalgia, and alcohol withdrawal support
- Cost-effective generic availability improves accessibility
Common use
Trazodone is primarily indicated for the treatment of major depressive disorder (MDD) in adults. Its sedating properties have also led to widespread off-label use for insomnia, particularly in cases where sleep initiation or maintenance is impaired. Clinicians may prescribe it for generalized anxiety disorder, as an adjunct in panic disorder, or to mitigate agitation in dementia patients. Its use in veterinary medicine for anxiety and behavioral issues in dogs is also documented.
Dosage and direction
For depression: Initial dose is 150 mg/day in divided doses, increased by 50 mg/day every 3–4 days to a maximum of 400 mg/day for outpatients or 600 mg/day for inpatients.
For insomnia: Lower doses are typical, ranging from 25–100 mg administered 30 minutes before bedtime.
Dosage should be individualized based on therapeutic response and tolerability. Tablets should be taken shortly after a meal or light snack to reduce dizziness. Do not crush or chew extended-release formulations.
Precautions
- Use with caution in patients with cardiac conditions due to risk of QT prolongation
- Monitor for serotonin syndrome, especially when co-administered with other serotonergic drugs
- Orthostatic hypotension may occur; advise rising slowly from sitting/lying positions
- Priapism (prolonged, painful erection) is a rare but serious side effect requiring immediate medical attention
- May impair cognitive or motor performance; avoid driving or operating machinery until effects are known
- Not recommended during pregnancy unless potential benefits outweigh risks (Pregnancy Category C)
Contraindications
- Hypersensitivity to trazodone or any component of the formulation
- Concurrent use with MAOIs or within 14 days of discontinuing MAOI therapy
- History of priapism
- Acute recovery phase after myocardial infarction
- Severe hepatic or renal impairment without dosage adjustment
Possible side effect
Common (≥1%):
- Drowsiness
- Dizziness
- Dry mouth
- Headache
- Nausea
- Blurred vision
Less common:
- Constipation
- Fatigue
- Weight changes
- Hypotension
- Confusion (especially in elderly patients)
Rare but serious:
- Priapism
- Serotonin syndrome
- Suicidal ideation (particularly in young adults)
- Cardiac arrhythmias
- Hyponatremia
Drug interaction
- Strong CYP3A4 inhibitors (e.g., ketoconazole, ritonavir) increase trazodone levels
- MAOIs may precipitate serotonin syndrome
- CNS depressants (alcohol, benzodiazepines, opioids) potentiate sedation
- Antihypertensives may enhance hypotensive effects
- Digoxin and phenytoin levels may be increased
- Warfarin: monitor INR due to potential increased anticoagulant effect
Missed dose
If a dose is missed, take it as soon as remembered unless it is near the time of the next dose. Do not double the dose to catch up. For once-daily bedtime dosing, skip the missed dose if it is already the next morning.
Overdose
Symptoms may include severe drowsiness, vomiting, priapism, respiratory depression, seizures, or cardiac arrhythmias. Management includes gastric lavage, activated charcoal, and supportive care. There is no specific antidote. ECG monitoring is advised due to risk of QT prolongation. Contact a poison control center immediately.
Storage
Store at room temperature (20–25°C/68–77°F) in a tightly closed container. Protect from light and moisture. Keep out of reach of children and pets. Do not use after the expiration date printed on the packaging.
Disclaimer
This information is for educational purposes only and does not constitute medical advice. Always consult a healthcare professional before starting, changing, or discontinuing any medication. Individual response to trazodone may vary based on health status, concomitant medications, and other factors.
Reviews
Clinical studies and meta-analyses consistently support trazodone’s efficacy in improving sleep parameters and depressive symptoms. Patient reviews often highlight improved sleep quality and mood stabilization, though some report residual morning drowsiness. Physicians appreciate its versatility and safety profile, particularly in elderly populations and those with comorbid insomnia and depression. Long-term adherence is generally favorable due to its tolerability and minimal withdrawal effects upon discontinuation.