Trazodone Oral: Uses, Side Effects, Interactions, Pictures, Warnings & Dosing

Warnings:

Antidepressant medications are used to treat a variety of conditions, including depression and other mental/mood disorders. These medications can help prevent suicidal thoughts/attempts and provide other important benefits. However, studies have shown that a small number of people (especially people younger than 25) who take antidepressants for any condition may experience worsening depression, other mental/mood symptoms, or suicidal thoughts/attempts. It is very important to talk with the doctor about the risks and benefits of antidepressant medication (especially for people younger than 25), even if treatment is not for a mental/mood condition.

Tell the doctor right away if you notice worsening depression/other psychiatric conditions, unusual behavior changes (including possible suicidal thoughts/attempts), or other mental/mood changes (including new/worsening anxiety, panic attacks, trouble sleeping, irritability, hostile/angry feelings, impulsive actions, severe restlessness, very rapid speech). Be especially watchful for these symptoms when a new antidepressant is started or when the dose is changed.

Warnings:

Antidepressant medications are used to treat a variety of conditions, including depression and other mental/mood disorders. These medications can help prevent suicidal thoughts/attempts and provide other important benefits. However, studies have shown that a small number of people (especially people younger than 25) who take antidepressants for any condition may experience worsening depression, other mental/mood symptoms, or suicidal thoughts/attempts. It is very important to talk with the doctor about the risks and benefits of antidepressant medication (especially for people younger than 25), even if treatment is not for a mental/mood condition.

Tell the doctor right away if you notice worsening depression/other psychiatric conditions, unusual behavior changes (including possible suicidal thoughts/attempts), or other mental/mood changes (including new/worsening anxiety, panic attacks, trouble sleeping, irritability, hostile/angry feelings, impulsive actions, severe restlessness, very rapid speech). Be especially watchful for these symptoms when a new antidepressant is started or when the dose is changed.

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Uses

This medication is used to treat depression. It may help to improve your mood, appetite, and energy level as well as decrease anxiety and insomnia related to depression. Trazodone works by helping to restore the balance of a certain natural chemical (serotonin) in the brain.

How to use Trazodone HCL

Read the Medication Guide provided by your pharmacist before you start using trazodone and each time you get a refill. If you have any questions, consult your doctor or pharmacist.

Take this medication by mouth after a meal or snack as directed by your doctor, usually once or twice daily. If drowsiness is a problem and you are taking 1 dose daily, take it at bedtime. If you are taking 2 doses each day, it may help to take 1 of the doses at bedtime. Follow your doctor’s directions carefully.

Dosage is based on your medical condition and response to treatment. To reduce your risk of side effects, your doctor may start you at a low dose and gradually increase your dose.

Take this medication exactly as prescribed. Do not increase your dose or take this medication more often than prescribed. Your condition will not improve any faster, and the risk of serious side effects may be increased.

Keep taking this medication as prescribed even if you feel well. To help you remember, take it at the same time(s) each day. Do not stop taking this medication without consulting your doctor. Anxiety, agitation, and trouble sleeping can occur if the drug is suddenly stopped.

It may take 2 to 4 weeks before you notice the full effects of this medication. Tell your doctor if your condition lasts or gets worse.

Side Effects

See also the Warning section.

Nausea, vomiting, diarrhea, drowsiness, dizziness, tiredness, blurred vision, changes in weight, headache, muscle ache/pain, dry mouth, bad taste in the mouth, stuffy nose, constipation, or change in sexual interest/ability may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.

To relieve dry mouth, suck on (sugarless) hard candy or ice chips, chew (sugarless) gum, drink water, or use a saliva substitute.

To reduce the risk of dizziness and lightheadedness, get up slowly when rising from a sitting or lying position.

Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

Tell your doctor right away if you have any serious side effects, including: shaking (tremors), nightmares, ringing in the ears, problems urinating, blood in urine, signs of infection (such as such as sore throat that doesn’t go away, fever), shortness of breath, stomach/abdominal pain.

Get medical help right away if you have any very serious side effects, including: chest/jaw/left arm pain, fainting, fast/irregular heartbeat, seizures, eye pain/swelling/redness, widened pupils, vision changes (such as seeing rainbows around lights at night).

This medication may increase serotonin and rarely cause a very serious condition called serotonin syndrome/toxicity. The risk increases if you are also taking other drugs that increase serotonin, so tell your doctor or pharmacist of all the drugs you take (see Drug Interactions section). Get medical help right away if you develop some of the following symptoms: fast heartbeat, hallucinations, loss of coordination, severe dizziness, severe nausea/vomiting/diarrhea, twitching muscles, unexplained fever, unusual agitation/restlessness.

Rarely, males may have a painful or prolonged erection lasting 4 or more hours. If this occurs, stop using this drug and get medical help right away, or permanent problems could occur.

A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.

This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.

In the US – Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.

In Canada – Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

Precautions

Before taking trazodone, tell your doctor or pharmacist if you are allergic to it; or to nefazodone; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

Before using this medication, tell your doctor or pharmacist your medical history, especially of: personal or family history of bipolar disorder, personal or family history of suicide attempts, heart disease (such as irregular heartbeat, heart attack), liver disease, kidney disease, blood pressure problems, personal or family history of glaucoma (angle-closure type).

This drug may make you dizzy or drowsy or blur your vision. Alcohol or marijuana (cannabis) can make you more dizzy or drowsy. Do not drive, use machinery, or do anything that needs alertness or clear vision until you can do it safely. Limit alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).

Trazodone may cause a condition that affects the heart rhythm (QT prolongation). QT prolongation can rarely cause serious (rarely fatal) fast/irregular heartbeat and other symptoms (such as severe dizziness, fainting) that need medical attention right away.

The risk of QT prolongation may be increased if you have certain medical conditions or are taking other drugs that may cause QT prolongation. Before using trazodone, tell your doctor or pharmacist of all the drugs you take and if you have any of the following conditions: certain heart problems (heart failure, slow heartbeat, QT prolongation in the EKG), family history of certain heart problems (QT prolongation in the EKG, sudden cardiac death).

Low levels of potassium or magnesium in the blood may also increase your risk of QT prolongation. This risk may increase if you use certain drugs (such as diuretics/”water pills”) or if you have conditions such as severe sweating, diarrhea, or vomiting. Talk to your doctor about using trazodone safely.

Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).

Older adults may be more sensitive to the side effects of this drug, especially drowsiness, dizziness, and QT prolongation (see above).

During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.

Since untreated mental/mood problems (such as depression) can be a serious condition, do not stop taking this medication unless directed by your doctor. If you are planning pregnancy, become pregnant, or think you may be pregnant, immediately discuss with your doctor the benefits and risks of using this medication during pregnancy.

This medication passes into breast milk. Consult your doctor before breast-feeding.

Interactions

Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor’s approval.

A product that may interact with this drug is: digoxin.

Taking MAO inhibitors with this medication may cause a serious (possibly fatal) drug interaction. Avoid taking MAO inhibitors (isocarboxazid, linezolid, metaxalone, methylene blue, moclobemide, phenelzine, procarbazine, rasagiline, safinamide, selegiline, tranylcypromine) during treatment with this medication. Most MAO inhibitors should also not be taken for two weeks before and after treatment with this medication. Ask your doctor when to start or stop taking this medication.

Other medications can affect the removal of trazodone from your body, which may affect how trazodone works. Examples include azole antifungals (such as itraconazole, ketoconazole), HIV protease inhibitors (such as indinavir), macrolide antibiotics (such as erythromycin), ritonavir, drugs used to treat seizures (such as phenytoin), among others.

The risk of serotonin syndrome/toxicity increases if you are also taking other drugs that increase serotonin. Examples include street drugs such as MDMA/”ecstasy,” St. John’s wort, certain antidepressants (including SSRIs such as fluoxetine/paroxetine, SNRIs such as duloxetine/venlafaxine), among others. The risk of serotonin syndrome/toxicity may be more likely when you start or increase the dose of these drugs.

Tell your doctor or pharmacist if you are taking other products that cause drowsiness including alcohol, marijuana (cannabis), antihistamines (such as cetirizine, diphenhydramine), drugs for sleep or anxiety (such as alprazolam, diazepam, zolpidem), muscle relaxants, and opioid pain relievers (such as codeine).

Check the labels on all your medicines (such as allergy or cough-and-cold products) because they may contain ingredients that cause drowsiness. Ask your pharmacist about using those products safely.

Does Trazodone HCL interact with other drugs you are taking?

Enter your medication into the WebMD interaction checker

Overdose

If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: painful/prolonged erection, slow/rapid/irregular heartbeat, unusual drowsiness, unusual dizziness, vomiting, trouble breathing, seizures.

Do not share this medication with others.

Lab and/or medical tests should be done while you are taking this medication. Keep all medical and lab appointments. Consult your doctor for more details.

If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.

Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.

Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

Images

trazodone 100 mg tablet

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This medicine is a white, round, scored, tablet imprinted with “8 06”.

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This medicine is a white, round, scored, tablet imprinted with “8 06”.

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This medicine is a white, round, scored, tablet imprinted with “8 06”.

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trazodone 100 mg tablet

Color: whiteShape: roundImprint: PLIVA 434

This medicine is a white, round, scored, tablet imprinted with “8 06”.

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trazodone 300 mg tablet

Color: whiteShape: ovalImprint: 13 33 100 100 100

This medicine is a white, round, scored, tablet imprinted with “8 06”.

trazodone 100 mg tablet

Color: whiteShape: roundImprint: 13 31

This medicine is a white, round, scored, tablet imprinted with “8 06”.

trazodone 50 mg tablet

Color: whiteShape: roundImprint: 13 30

This medicine is a white, round, scored, tablet imprinted with “8 06”.

trazodone 100 mg tablet

Color: whiteShape: roundImprint: MP 114

This medicine is a white, round, scored, tablet imprinted with “8 06”.

trazodone 150 mg tablet

Color: whiteShape: ovalImprint: PLIVA 441 50 50 50

This medicine is a white, round, scored, tablet imprinted with “8 06”.

trazodone 150 mg tablet

Color: whiteShape: ovalImprint: IT 150 50 50 50

This medicine is a white, round, scored, tablet imprinted with “8 06”.

trazodone 300 mg tablet

Color: whiteShape: ovalImprint: PLIVA 733 100 100 100

This medicine is a white, round, scored, tablet imprinted with “8 06”.

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Color: whiteShape: ovalImprint: APO T300 100 100 100

This medicine is a white, round, scored, tablet imprinted with “8 06”.

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Color: whiteShape: ovalImprint: barr 733 100 100 100

This medicine is a white, round, scored, tablet imprinted with “8 06”.

trazodone 300 mg tablet

Color: whiteShape: ovalImprint: IT 300 100 100 100

This medicine is a white, round, scored, tablet imprinted with “8 06”.

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Selected from data included with permission and copyrighted by First Databank, Inc. This copyrighted material has been downloaded from a licensed data provider and is not for distribution, except as may be authorized by the applicable terms of use.

CONDITIONS OF USE: The information in this database is intended to supplement, not substitute for, the expertise and judgment of healthcare professionals. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or anyone else. A healthcare professional should be consulted before taking any drug, changing any diet or commencing or discontinuing any course of treatment.

Antidepressant, Sleeping Pill, or Both?

Although trazodone was designed to treat depression and anxiety disorders, the medication is now widely prescribed as a nighttime sleep aid

What is trazodone?

Trazodone was developed in Italy in the 1960s as an antidepressant medication. Due to negative side effects associated with the drug early on—including dizziness, fainting, irregular heartbeat (and in rare cases, priapism in men)—the antidepressant wasn’t widely favored in the medical community. Eventually, however, internists and clinicians recognized potential benefits of the drug, particularly when administered at low doses. In 1981, trazodone (the generic name of the pharmaceutical) was approved by the U.S. Food and Drug Administration (FDA) under the brand name Desyrel for use in treating major depressive disorder. Today, the medication is prescribed under the brand name Oleptro to treat sleep disorders such as insomnia as well as anxiety disorder and unipolar depression.

Does trazodone cause sleepiness?

For many patients, the drug has a sedative effect, inducing a relaxed, sleepy feeling. In prescribing the drug for sleep disorders, physicians typically recommend taking a low dose at bedtime in order to limit the effects of drowsiness. Still, some people report lingering effects, including sluggishness and feeling zapped of energy, particularly upon waking.

How does trazodone help to alleviate depression?

Trazodone increases natural neurotransmitters in the central nervous system, essentially restoring depleted chemicals in the brain. One of these important neurotransmitters—serotonin—regulates our internal clock for resting and being awake, as well as mood, appetite, digestion, memory, sexual function and desire. Many experts believe depression involves an imbalance among the brain’s neurotransmitters (acetylcholine, norepinephrine, dopamine and serotonin.) While the cause of depression is not fully understood, trazodone affects the brain’s neurotransmitters by inhibiting the uptake of serotonin by nerves and stimulating other nerves.

How quickly does the drug take effect?

Patients who take the drug for a sleep disorder can experience the sedative effects within 30 minutes, depending on the type used. Patients who take the drug as an antidepressant may not notice symptom relief for one to two weeks, and it may take up to four weeks to experience the full benefits.

Is it safe to take trazodone to treat depression?

Like all medications, trazodone can cause side effects in some people. Ask your physician to discuss all potential side effects as well as drug interactions and potential withdrawal symptoms associated with the medication.

Do all antidepressant drugs work the same way?

While all antidepressant medications are designed to affect brain chemistry, various pharmaceutical formulations of the drugs have different targets and paths. The most commonly prescribed antidepressants are reuptake inhibitors. Reuptake, as described by WebMD, is “the process in which neurotransmitters are naturally reabsorbed back into nerve cells in the brain after they are released to send messages between nerve cells. ” A reuptake inhibitor, then, keeps levels of neurotransmitters in the gap between nerves, potentially strengthening circuits in the brain that regulate mood. There are three different types: selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), and norepinephrine and dopamine reuptake inhibitors (NDRIs). Common SSRIs are Prozac, Zoloft, Paxil, Lexapro, Celexa and Luvox; common SNRIs include Cymbalta and Effexor; and NDRIs are found in only one drug: Wellbutrin.

Because trazodone doesn’t fall under any of these categories, it’s often referred to as an “atypical antidepressant.”

Is it safe to take trazodone for insomnia?

Although trazodone was designed to treat depression and anxiety disorders, the medication is now widely prescribed as a nighttime sleep aid for patients who suffer from acute insomnia.

How is trazodone different from other “sleeping pill” drugs?

Trazodone differs from Ambien, Sonata, Lunesta and other “sleeping pill” medications in a few ways:

• Both Ambien and Lunesta are classified by the FDA as controlled substances because they have the potential for misuse and abuse, including dependence or addiction
• Because trazodone is not a controlled substance, physicians aren’t limited in how many pills they can prescribe
• It’s an inexpensive generic drug covered by most insurance companies
• It’s not considered to be an addictive substance when used as prescribed

Trazodone should not be taken by pregnant women or women who are breastfeeding.

What risks are associated with taking trazodone to treat depression?

There are heightened risks for patients under age 24, particularly with regard to mental health. According to Medline Plus, the following side effects and symptoms can occur among patients under age 24: “new or worsening depression; thinking about harming or killing yourself, or planning or trying to do so; extreme worry; agitation; panic attacks; difficulty falling asleep or staying asleep; aggressive behavior; irritability; acting without thinking; severe restlessness; and frenzied abnormal excitement.” If any of these symptoms or side effects are experienced, it’s crucial to consult a physician or medical professional immediately.

It’s also imperative that patients know what to avoid while taking SSRIs, SNRIs or other antidepressants. Whether a person has a cold, is having trouble sleeping or is searching for allergy relief, they should talk to their doctor before self-treating with an over-the-counter medication. According to Psychiatry Advisor, one patient who was taking melatonin for insomnia while also prescribed an SSRI woke up with a “headache, dizziness and feeling like his face was on fire”—signs of elevated blood pressure that could have been severe had he taken higher doses. Taking an antidepressant medication in combination with supplements, such as St. John’s wort or aspirin, can increase the likelihood of upper gastrointestinal bleeding. To avoid adverse drug reactions, experts advise making a list of all medications, supplements and other OTC drugs, and sharing it with your physician prior to taking trazodone.

Is it safe to use trazodone with alcohol or other drugs?

Absolutely not. Since both alcohol and trazodone affect the central nervous system, the consequences of mixing the two can be deadly. And mixing the medication with drugs of abuse can result in the onset of serotonin syndrome, a potentially lethal adverse drug reaction. While the potential for trazodone abuse is fairly low, any amount over 600 mg. in 24 hours is an overdose.

What happens if you take too much trazodone? Can it cause serotonin syndrome?

Serotonin syndrome occurs when, according to Mayo Clinic, “high levels of serotonin accumulate in the body.” This is a drug-to-drug interaction involving the over-stimulation of central and peripheral receptors. According to the journal U.S. Pharmacist, “Serotonin syndrome (SS) is caused most often when certain antidepressant agents are taken concurrently with other drugs that modulate synaptic serotonin levels. When patients take two or more antidepressants from different pharmacologic classes, drug-drug interactions may occur; these interactions may lead to potentially severe serotonin toxicity, or serotonin syndrome.” Clinical symptoms of serotonin syndrome can develop within two hours—or up to 24 hours—after taking an increased dose or adding another serotonergic drug.

Signs and symptoms of serotonin syndrome:

• Tremors
• Muscle aches
• Sweating
• Anxiety
• Confusion
• Tachycardia
• Delirium
• Hallucinations
• Seizures
• Renal failure
• Death

What are the side effects of trazodone?

Trazodone usage can cause a decrease in sodium levels in the body, a disruption of the nervous system or serotonin syndrome. The most common side effects include:

• Drowsiness (including feeling groggy the next day)
• Dizziness (including an increased risk of fainting/falling)
• Dry mouth
• Constipation
• Headache
• Fatigue
• Tingling or numbness in hands, arms or legs
• Blurred vision
• Disorientation
• Vertigo
• Nasal congestion
• Shaking
• Anxiety
• Muscle aches
• Prolonged and painful erections lasting longer than six hours (priapism) 
• Abnormally low blood pressure
• Heart rhythm disorders 
• Increased risk of suicidal thoughts and behavior in children and adolescents (even when taken at approved doses for depression)
• Acting on dangerous impulses
• Insomnia (at high doses)
• Weight gain or loss

The drug can stay in a person’s system for 42 hours after the final dose. Higher doses can produce more severe side effects.

Can you become addicted to trazodone?

While the drug is considered non-addictive and non-habit-forming, it should only be taken as prescribed and under a physician’s care in order to avoid misuse. This is especially important for individuals who have a history of substance abuse or other drug addiction. Warning signs of drug misuse include using the sleep aid/antidepressant without a prescription, using the medication at higher doses than prescribed, or snorting or crushing the tablets to speed up the intended effects.

Can you fail a drug test while taking trazodone?

Even though the antidepressant/sleep aid is not classified as a narcotic, it can cause false positives on drug tests. According to the National Center for Biotechnology Information, “The trazodone metabolite meta-Chlorophenylpiperazine [m-CPP] can cause false-positive urine amphetamine immunoassay results.…Further, we found that patients taking trazodone can produce urine with sufficient m-CPP to result in false-positive Amphetamines II results.”

What are trazodone’s withdrawal symptoms?

Although technically a non-addictive substance, regular use of the medication can result in mild physical dependence. For this reason, trazodone withdrawal is a concern. Rather than discontinuing use “cold-turkey,” physicians typically recommend a gradual tapering. This approach is considered a better protocol to avoid potential discomfort associated with trazadone withdrawal syndrome, also known as discontinuation syndrome.

Symptoms of trazodone withdrawal include:

• Agitation
• Confusion
• Rapid mood swings
• Muscle pain
• Weakness
• Dizziness
• Stomach pain
• Sweating
• Insomnia
• Fatigue

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Use of trazodone (trittico) | News and promotions of the European Medical Center “UMMC-Health”

Erectile dysfunction is a disease characterized by “persistent inability to achieve or maintain an erection sufficient for satisfactory sexual intercourse” (1). It is difficult to overestimate the psychological significance for a man and for family relations of this disease (2).

Until the beginning of the twentieth century, psychogenic erectile dysfunction was considered the main cause of erectile dysfunction. Currently, 80% of patients are diagnosed with organic causes of the disease (3).

The occurrence of erectile dysfunction has a very clear age dependence.

The Massachusetts male aging study showed that 12.4% had erectile dysfunction between the ages of 40 and 49, 29.8% between the ages of 50 and 59, and 29.8% between the ages of 60 and 69. in 46.6% of patients (4). In addition to age, diseases such as diabetes mellitus, vascular heart disease, hypertension, depression are directly related to the occurrence of erectile dysfunction (5).

According to the doctor of medical sciences, president of PAAR Shcheplev PA, erectile dysfunction in 25% of cases is of a purely organic nature (vascular disorders, diabetes mellitus, medications, neurological and endocrine disorders, operations on the pelvic organs), 25% is purely psychogenic and in 50% of cases is the result of several reasons.

Thus, the significance of psychogenic causes in the structure of erectile dysfunction, although it has decreased, remains quite high. Of particular relevance are issues related to the treatment of depression in combination with erectile dysfunction.

Depressed men have a risk of developing erectile dysfunction ranging from 25% for mild depression to 90% for severe depression (6).

The frequency and variety of forms of psychogenic erectile dysfunction (7) in the practice of an andrologist determines the search for drugs that simultaneously affect both the psychogenic factor of the disease (anxiety, depression, asthenic syndrome) and the erection mechanisms themselves.

Trazodone hydrochloride (trittico) is used as an antidepressant and has anti-anxiety (anxiolytic), sedative and hypnotic effects. Because of the reported improvement in erectile function with trazodone, this drug has been used to treat erectile dysfunction (8).

The mechanism of action of trazodone (trittiko) is associated with selective suppression of serotonin reuptake and a powerful blockade of 5HT2a receptors _, , which causes its antidepressant effect. Antagonism towards α2-adrenergic receptors of the smooth muscles of the vessels of the penis and smooth muscles of the cavernous bodies, leading to their relaxation, possibly causes the effect of trazodone to induce an erection and improve erectile function. (9,10) .

Moderate blockade of 5HT1a serotonin receptors (10 times less than 5HT2a), reduces the likelihood of their hyperstimulation effect, and the manifestation of side effects characteristic of selective serotonin reuptake inhibitors, such as psychomotor agitation, restlessness, insomnia, headache, anxiety , loss of appetite, nausea, vomiting and diarrhea.

Thus, the mechanism of action of trazodone (trittico) suggests the possible effectiveness of the use of this drug in the complex treatment of psychogenic erectile dysfunction and erectile dysfunction of mixed origin, where the psychogenic component is clinically significant.

In the foreign literature, there are a number of studies on the use of trazodone for the treatment of erectile dysfunction.

G. A. Fink et al conducted a meta-analysis of the Medline database and the Cochrane Library from January 1966 to May 2002 (11). Six studies with 396 male subjects met the inclusion criteria. Three studies showed a significant clinical effect of trazodone in the treatment of erectile dysfunction compared with placebo. Two studies showed a statistically significant efficacy of trazodone compared with placebo (37% versus 20%). The analysis performed suggested that men with psychogenic erectile dysfunction are more likely to have satisfactory results from taking trazodone than men with mixed or organic erectile dysfunction. The effectiveness of trazodone in the treatment of erectile dysfunction also depended on the dose of the drug, the best result was achieved when taking 150-200 mg per day than when taking 50 mg. The conclusion from this work is that trazodone may improve erectile quality in men with erectile dysfunction, especially at higher doses and in men with psychogenic erectile dysfunction (10).

A study by Kurt W 1994 (12) showed a greater likelihood of three or more successful intercourse attempts in patients with psychogenic erectile dysfunction treated with trazodone compared to those treated with placebo .

In a study by Montorsi F. 1994 (13) in men with psychogenic erectile dysfunction, trazodone 50 mg daily in combination with yohimbine 5 mg three times daily had more likely to have a satisfactory erection than with placebo (50% versus 11%).

At the same time, in a study by Costabile R.A. 1999 (14), in which men with organic erectile dysfunction participated, treatment with trazodone at a dose of 50 mg per day improves erection no better than placebo.

In a meta-analysis of 6 studies, Fink et al. G. A. 2003 (11) report the following side effects of trazodone: dry mouth (19% vs. 11% with placebo), sedation (16% vs. 6%) , dizziness (16% vs 0%) and fatigue (15% vs 8%). Priapism was observed in only one man taking trazodone in one of the studies, in the placebo groups this effect was never seen.

In the domestic literature there are separate studies on the use of the drug trazodone (trittiko) for the treatment of erectile dysfunction.

Tak Tkachuk V.N., Lukyanov A.E 2006 (15) in his study involving 135 patients with psychogenic erectile dysfunction aged 22 to 56 years (mean was 32.2±3.4 years ) Trittico was used at a dose of 150 mg once a day for 6 weeks. The IIEF scale was used to assess the effectiveness of treatment.

Erectile function after treatment with trazodone (trittiko) was satisfactory.

Materials and methods.

The data of our study at the polyclinic base of the Clinic LLC “City Hospital No. 41” and the Clinic “Health 365” from 2007 to 2010 include 36 patients who were prescribed trittiko due to various sexual problems, the age of the patients was from 17 up to 53 years old.

All patients were divided into three groups.

The first group included patients suffering from various sexual disorders, predominantly of psychogenic origin, but with satisfactory erectile function, a total of 6 patients.

The second group included patients suffering from purely psychogenic erectile dysfunction, a total of 20 patients.

The third group included patients with mixed erectile dysfunction, where the psychogenic component was clinically significant, in total 10 patients.

All patients in the complex of treatment included rational and suggestive psychotherapy, selective partner sex therapy and the drug trazodone (trittiko) 150 mg per day for 30-60 days. In addition, depending on the nature of the etiological factor and the severity of the disease, the treatment complex included adaptogens, type 5 phosphodiesterase inhibitors, and local decompression courses.

Results were assessed using the International Erectile Function Index (IIEF).

Results.

First group.

It included 6 patients aged 17 to 33 years. All of them suffered from neurosis of expectation of failure, and in 2 patients the neurosis was combined with a depressive syndrome and decreased libido, in another 2 patients with psychogenic anejaculatory syndrome and in 2 patients with premature ejaculation syndrome. All patients were prescribed trazodone (trittiko) at a dose of 150 mg for 60 days as monotherapy. Against the background of drug therapy for the treatment of failure expectation neurosis, rational and suggestive psychotherapy was carried out, and for the treatment of psychogenic anejaculatory syndrome and premature ejaculation syndrome, partner sex therapy was carried out.

General satisfaction with sexual function in patients of this group after treatment increased from 4 to 9 points.

Second group.

It included 23 patients with psychogenic erectile dysfunction aged 20 to 52 years. All of them suffered from failure expectation neurosis of varying degrees. At the same time, in one patient, neurosis was combined with an organic personality disorder, in two – with severe onanophobia, which led to social maladaptation of patients, in two – with a syndrome of coded sexual reactions, and in one – with a hysterical syndrome. The patients of this group were divided into three subgroups according to the degree of erectile dysfunction.

1. Of seven patients with mild erectile dysfunction, trazodone (trittico) was given as monotherapy, and five were given in combination with phosphodiesterase type 5 inhibitors with good effect.

Erectile function score increased from 17 to 23 points.

2. Of the eight patients with moderate erectile dysfunction, in addition to trazodone (trittico) and phosphodiesterase type 5 inhibitors, two were prescribed aphrodisiacs, and two additionally received a course of local decompression.

In six patients the result was satisfactory. The evaluation of erectile function has risen from 11 to 23 points.

In one patient with psychogenic erectile dysfunction, which included hysterical neurosis, the administration of trazodone (trittiko) and type 5 phosphodiesterase inhibitors in combination with rational and suggestive psychotherapy did not lead to an improvement in erectile function. Subsequently, the patient was referred to the Clinic of Neurosis for specialized psychotherapeutic treatment.

In one patient with psychogenic erectile dysfunction due to coded sexual response syndrome and prolonged sexual abstinence, despite the appointment of trazodone (trittiko), phosphodiesterase type 5 inhibitors, adaptogens in combination with rational and suggestive psychotherapy did not lead to an improvement in erectile function. He refused further treatment.

3. Of eight patients with severe erectile dysfunction, in addition to trazodone (trittico) and phosphodiesterase type 5 inhibitors, two additionally received a course of local decompression. In 7 patients the result was satisfactory. The evaluation of erectile function has risen from 8 to 22 points.

One patient, despite taking trazodone (trittico), phosphodiesterase type 5 inhibitors, adaptogens, as well as multiple sessions of rational and suggestive psychotherapy, the neurosis of expectation of failure turned out to be extremely resistant, and there was no improvement in erectile function, he was offered endophalloprosthetics.

Third group.

It included 7 patients with mixed erectile dysfunction aged 21 to 51 years. All patients in this group were diagnosed with failure expectation neurosis, while in 4 patients erectile dysfunction had a significant vasculogenic factor, 2 had androgen deficiency, and 1 had a neurogenic factor (Thompson’s myopathy). All of them had a predominantly severe degree of erectile dysfunction.

Patients with androgen deficiency, in addition to testosterone replacement therapy, were prescribed trazodone (trittiko) and phosphodiesterase type 5 inhibitors with good effect.

A patient with Thompson’s myotonia, in addition to the main neurological treatment, was also prescribed trazodone (trittiko) and phosphodiesterase type 5 inhibitors with good effect.

Of the four patients with a vasculogenic component of erectile dysfunction, two received trazodone (trittico) in combination with a phosphodiesterase type 5 inhibitor, and another two were treated with local decompression. In two patients, the course of treatment was effective. Erectile function score rose from 7 to 22 points. Two patients with venous erectile dysfunction had no effect from the treatment.

Subsequently, due to the distal form of venous insufficiency of erection, an operation was performed to ligate the deep dorsal vein and circumflex veins with a good effect.

In the second patient, surgical treatment of venous erectile dysfunction did not give any effect, and the patient underwent endofalloprosthesis.

Conclusions.

1. In general, the drug trazodone (trittico) showed good efficacy in the treatment of psychogenic erectile dysfunction and erectile dysfunction of mixed origin, where the psychogenic component is clinically significant.

2. In some cases of psychogenic erectile dysfunction, in addition to the standard complex of treatment, including rational and suggestive psychotherapy, trazodone (trittiko), phosphodiesterase type 5 inhibitors, adaptogens, local decompression, specialized psychotherapeutic treatment is indicated when the sexological syndrome is only a component of a psychopathological disorder .

3. In cases of erectile dysfunction of mixed origin, with a significant vasculogenic component, treatment of vasculogenic dysfunction should be carried out first, despite the large clinical significance of the psychogenic component.

Literature.

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3. Melman A., Gingell J.C. The epidemiology and pathophysiology of erectile dysfunction // J. Urol. – 1999.

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Incidence of erectile dysfunction in men 40 to 69 years old: longitudinal results from the

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Trazodone – description of the substance, pharmacology, use, contraindications, formula

Contents

• Structural formula

• Russian name

• English name

• Latin name

• chemical name

• Gross formula

• Pharmacological group of the substance Trazodone

• Nosological classification

• CAS code

• pharmachologic effect

• Characteristic

• Pharmacology

• The use of the substance Trazodone

• Contraindications

• Application restrictions

• Use during pregnancy and lactation

• Side effects of Trazodone

• Interaction

• Overdose

• Dosage and administration

• Precautionary measures

• Trade names with the active ingredient Trazodone

Structural formula

Russian name

Trazodone

English name

Trazodone

Latin name

Trazodonum ( genus Trazodoni)

Chemical name

-on (as hydrochloride)

Gross formula

C ₁₉ H ₂₂ ClN ₅ O

Pharmacological group of the substance Trazodone

Antidepressants

Nosological classification

ICD-10 code list

CAS code

19794-93-5

Pharmacological action

Pharmacological action –

antidepressant .

Characteristic

Thiazolopyridine derivative; according to its chemical structure, it does not belong to tricyclic, tetracyclic or other groups of antidepressants. Trazodone hydrochloride is a white, odorless, crystalline powder that is readily soluble in water. Molecular weight 408.33.

Pharmacology

The mechanism of action is not fully understood. Preclinical studies have shown that trazodone selectively inhibits the reuptake of serotonin by brain synaptosomes and acts as a 5-HT _2A/2C serotonin receptor antagonist. Does not inhibit MAO, does not stimulate the central nervous system. It is an antagonist of alpha ₁ -adrenergic receptors.

Relieves mental (affective tension, fear, insomnia) and somatic (palpitations, headache, myalgia, frequent urination, increased sweating) manifestations of anxiety. Increases the depth and duration of sleep in depressed patients, restores the physiological structure of sleep.

Well absorbed from the gastrointestinal tract. Taking trazodone during or immediately after a meal slows down the absorption rate, reduces max “> C _max of trazodone in the blood and increases max”> T _max (T _max is 0.5–2 hours). Plasma protein binding 89-95%. Passes through histohematic barriers, including the BBB. It is metabolized in the liver, mainly with the participation of the CYP3A4 isoenzyme of cytochrome P450, the active metabolite is m-chlorophenylpiperazine. 1/2″>T _1/2 biphasic: early phase 3-6 hours, late 5-9h; in some patients cumulation is possible. Excreted in bile (20%) and urine (75%, including 70% as inactive metabolites) within 98 hours after ingestion.

There is evidence of the effectiveness of trazodone in bulimia, kleptomania, diabetic neuropathy pain syndrome and other types of chronic pain, phobias, incl. agoraphobia, panic attacks, acute withdrawal syndrome in alcoholism and for the prevention of migraine.

The use of the substance Trazodone

Depressive states of various etiologies (endogenous, psychotic, neurotic, somatogenic, etc. ) with severe anxiety, tension.

Contraindications

Hypersensitivity, alcohol intoxication and intoxication with sleeping pills, age up to 6 years.

Restrictions on use

Myocardial infarction (early recovery period), AV blockade, arterial hypertension (dose adjustment of antihypertensive drugs may be required), ventricular arrhythmia, history of priapism, liver and / or kidney failure, age up to 18 years.

Use in pregnancy and lactation

Should not be used by pregnant women. Animal studies have shown that trazodone at doses 30 to 50 times the MRHD causes congenital malformations and increases the rate of fetal resorption.

FDA fetal category C.

Stop breastfeeding during treatment. Trazodone and its metabolites are found in the milk of lactating rats. It is not known whether trazodone is secreted into human breast milk.

Side effects of the substance Trazodone

From the nervous system and sensory organs: fatigue, weakness, headache, dizziness, insomnia, drowsiness, agitation, psychosis, hypomania, hallucinations, tremor, muscle twitching, grand mal seizures (grand mal) , aphasia, ataxia, akathisia, dyskinesia, paresthesia, confusion, syncope, blurred vision, diplopia.

From the side of the cardiovascular system and blood (hematopoiesis, hemostasis): arterial hypotension, incl. orthostatic; atrial fibrillation, arrhythmias (including tachycardia and bradycardia, ectopic ventricular rhythms), congestive heart failure, leukocytosis or leukopenia, neutropenia (usually minor), hemolytic anemia, methemoglobinemia.

From the digestive tract: increased appetite, dryness and unpleasant taste in the mouth, hypersalivation, caries, diseases of the periodontal tissues, candidiasis of the oral cavity, nausea, vomiting, flatulence, diarrhea, constipation, cholestasis, increased levels of bilirubin and amylase in plasma blood, jaundice.

From the genitourinary system: urinary retention, increased urination, hematuria, premature menstruation, hirsutism, increased libido, priapism, impotence, retrograde ejaculation.

Allergic reactions: skin rash, urticaria.

Other: myalgia, chest pain, alopecia, psoriasis, edema.

Interaction

Unlike typical antidepressants, it does not reduce the depriming effects of reserpine, weakens the central effect of amphetamine and the peripheral effect of norepinephrine. Potentiates the effect of drugs that depress the central nervous system (including barbiturates, tricyclic antidepressants, antihistamines, clonidine, alcohol), anticholinergics and muscle relaxants. When taken simultaneously with antihypertensive drugs, the risk of orthostatic hypotension increases. Weakens the effect of psychostimulants. Increases the plasma concentration of digoxin and phenytoin. It should not be used simultaneously with MAO inhibitors.

Overdose

Symptoms: nausea, vomiting, drowsiness, dizziness, lowering blood pressure, impaired coordination, priapism, epileptiform seizures, ECG changes, respiratory arrest, worsening of adverse reactions.

Treatment: gastric lavage, forced diuresis, activated charcoal, maintenance of vital functions, symptomatic therapy. There is no specific antidote.

Dosage and Administration

Orally . Adults: the initial dose is 100 mg, once at bedtime, if necessary, the dose is increased by 50 mg / day every 3-4 days until a therapeutic effect is achieved. The maximum daily dose on an outpatient basis is 450 mg, in stationary conditions – 600 mg. For elderly and debilitated patients, the initial dose is up to 100 mg / day, if necessary, can be increased to 300 mg / day. Children 6–18 years: 1.5–2 mg/kg/day, if necessary, increase the dose to 6 mg/kg/day.

Precautions

During treatment, a complete blood count should be performed regularly (for the timely detection of leuko- and neutropenia), ECG monitoring is desirable in patients with cardiovascular diseases. Careful monitoring of patients with suicidal tendencies is required, especially in the first weeks of treatment. Treatment is immediately stopped with the development of priapism, severe neutro- and leukopenia; in other cases, drug withdrawal should be carried out gradually.