Common questions about trazodone – NHS

How does trazodone work?

Serotonin and noradrenaline are chemicals in the brain that help improve your mood. When your levels of these chemicals are low, you can get depressed.

Trazodone helps increase your levels of serotonin and noradrenaline so you feel better.

How will it make me feel?

In the first few days, trazodone may make you feel sleepy.

Antidepressants like trazodone help to improve your mood so you feel better.

You may notice that you sleep better and get on with people more easily because you’re less anxious.

You’ll hopefully be more relaxed about things that used to worry you.

Trazodone will not change your personality, it will simply help you feel like yourself again.

When will I feel better?

Do not expect to feel better overnight. Trazodone can take 1 to 2 weeks to start to work, and it can be 4 to 6 weeks before you feel the full benefit. Give the medicine at least 6 weeks to work.

Some people feel worse during the first few weeks of treatment before they begin to feel better.

During this time, some people occasionally have thoughts of harming themselves or ending their lives. If this happens to you, it’s very important to get help immediately – call 999 or go to A&E.

If you need more help, you can also contact the Samaritans.

Are there any long-term side effects?

Trazodone is safe to take for a long time. There do not seem to be any lasting harmful effects from taking it for many months, or even years.

Some people need to take trazodone long term to treat depression or anxiety that keeps coming back.

If you need it and do not get side effects, there’s no reason to worry about taking trazodone for a long time.

Is trazodone addictive?

There’s no evidence that trazodone is addictive. But you may get withdrawal side effects if you stop taking it suddenly.

This can cause sleep problems, leave you feeling irritable and you may sweat more than usual.

To prevent any withdrawal side effects, talk to your doctor about the best way to come off trazodone. They’ll explain how to reduce your dose gradually.

How does trazodone compare with other antidepressants?

Trazodone is not usually the first choice of antidepressant.

Doctors usually prescribe it when other antidepressants have not worked or have caused side effects.

Trazodone is no better or worse than other antidepressants. Some people respond better to one antidepressant than another. Trazodone is less suitable for elderly people, who may get more side effects.

Your doctor will recommend an antidepressant for you based on any other health issues you have and the medicines you have tried already.

You may find trazodone helpful if you have anxiety and problems getting to sleep, or if you’re irritable and agitated.

If you are not feeling any better after 6 weeks, talk to your doctor.

Are there other treatments that can help depression or anxiety?

Antidepressants, including trazodone, are just one of several approaches to treating depression or anxiety.

Other potential treatments for depression include:

• talking therapy (such as cognitive behavioural therapy)
• exercise programmes

Other potential treatments for anxiety include:

• talking therapy (such as cognitive behavioural therapy)
• joining a self-help group
• using relaxation techniques

Choosing a treatment that’s most suitable for you depends on:

• how long you have had depression or anxiety
• your symptoms
• whether you have had depression or anxiety before
• whether previous treatment worked
• how likely you are to stick with your treatment
• the potential side effects
• your preferences and priorities

If you’re interested in any of these treatments, talk to your doctor.

Will my doctor prescribe trazodone to help me sleep?

Trazodone may make you sleepy. Because of this, it may be a suitable medicine if you have anxiety and difficulty sleeping (insomnia).

But your doctor will not prescribe it just to help you sleep. It has not been officially approved for this.

Can trazodone protect me against dementia?

At the moment, there’s no evidence that trazodone protects against dementia.

But it’s sometimes used to treat some symptoms of dementia, like irritability and agitation.

There are steps you can take that may reduce your risk of dementia.

If you’re worried about getting dementia or Alzheimer’s disease, or have a family history of these conditions, speak to your doctor.

Will I gain or lose weight?

Trazodone can make you feel more or less hungry than usual, so you may lose or gain weight when you start taking it.

If you start to have problems with your weight while taking trazodone, talk to your doctor or pharmacist.

Will it affect my contraception?

Trazodone does not affect any type of contraception, including the combined pill or emergency contraception.

Will it affect my sex life?

Trazodone can cause problems with ejaculation. Some people say it gives them a higher sex drive, others say it makes it lower.

Rarely, men may get a painful erection that lasts a long time that is not to do with sexual activity.

If you have a long-lasting and painful erection that lasts longer than 2 hours, go to A&E straight away.

Can I drive or ride a bike?

Trazodone may make you feel sleepy or less alert. Do not drive, cycle, or use tools or machinery until you know how this medicine affects you.

It’s an offence to drive a car if your ability to drive safely is affected. It’s your responsibility to decide if it’s safe to drive. If you’re in any doubt, do not drive.

Talk to your doctor or pharmacist if you’re unsure whether it’s safe for you to drive while taking trazodone. GOV.UK has more information on the law on drugs and driving.

Can I drink alcohol with it?

You can drink alcohol while taking trazodone, but it may make you feel sleepy.

It might be best to stop drinking alcohol until you see how the medicine makes you feel.

Is there any food or drink I need to avoid?

You can eat and drink normally while taking trazodone.

However, it’s a good idea to stop drinking alcohol until you see how the medicine makes you feel.

Will recreational drugs affect it?

Cannabis with trazodone can give you a fast heartbeat. Cannabis can also make drowsiness worse with trazodone, especially in people who have just started taking it.

Find out more about the side effects of some recreational drugs on the Frank website.

Page last reviewed: 9 March 2022

Next review due: 9 March 2025

Does trazodone cause weight gain?

Medically reviewed by Sally Chao, MD. Last updated on Sep 1, 2021.

Trazodone may cause weight gain for some people, but it is not a common side effect of the medication. Weight loss was shown to be slightly more common with trazodone.

Research on the drug suggests that the relationship between trazodone and weight change is mixed. While both weight gain and weight loss side effects are relatively rare compared to its other side effects, trazodone may be more likely to cause weight loss than weight gain. In a clinical trial, 5% of people who took trazodone gained weight, while 6% lost weight.

You may notice an increase or decrease in your appetite during treatment with trazodone, a side effect that may be managed with the help of your doctor.

Trazodone is one of many medications used to treat depression. Other antidepressants are more highly associated with weight gain than trazodone. While the reasons why antidepressants may affect weight are poorly understood, there are many connections between the regulation of mood, appetite and weight. One potential explanation is that people may experience an increase in appetite as their depression eases, resulting in weight gain.

For the most part, trazodone is thought to come with a lower risk of weight gain than some other types of antidepressants.

Other than weight changes, trazodone can also cause side effects such as:

• Swelling (edema)
• Blurry vision
• Fainting
• Fatigue and sleepiness
• Diarrhea
• Stuffy nose (sinus congestion)

References

1. U. S. Food and Drug Administration (FDA). DESYREL® (trazodone hydrochloride) tablets, for oral use. June 2017. Available at: https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/018207s032lbl.pdf. [Accessed August 2, 2021].
2. Wharton S, Raiber L, Serodio KJ. Medications that cause weight gain and alternatives in Canada: a narrative review. Diabetes Metab Syndr Obes. 2018;11:427-438. https://doi.org/10.2147/DMSO.S171365.
3. National Health Service ( NHS). Trazodone. December 13, 2018. Available at: https://www.nhs.uk/medicines/trazodone/. [Accessed August 2, 2021].
4. Lee SH, Paz-Filho G, Mastronardi C. Is increased antidepressant exposure a contributory factor to the obesity pandemic? Translational psychiatry . 2016;6(3), e759. https://doi.org/10.1038/tp.2016.25.
5. Carvalho AF, Sharma MS, Brunoni AR. The Safety, Tolerability and Risks Associated with the Use of Newer Generation Antidepressant Drugs: A Critical Review of the Literature. Psychother Psychosom. 2016;85(5):270-288. https://doi.org/10.1159/000447034
6. Albert U, Lamba P, Stahl SM. Early response to trazodone once-a-day in major depressive disorder: review of the clinical data and putative mechanism for faster onset of action. CNS Spectr. 2021;26(3):232-242. https://doi.org/10.1017/S1092852921000304.

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Drug information

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Medical Disclaimer

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

-one (as hydrochloride)

Gross formula

C ₁₉ H ₂₂ ClN ₅ O

Pharmacological group of the substance Trazodone

Antidepressants

Nosological classification

ICD-10 code list

• F13 Mental and behavioral disorders due to the use of sedatives or hypnotics

• F32 Depressive episode

• F33 Recurrent depressive disorder

• F34. 1 Dysthymia

• F41.2 Mixed anxiety and depressive disorder

• F52.0 Lack or loss of sexual desire

• R52 Pain, not elsewhere classified

• Z50. 2 Alcoholism rehabilitation

• Z50.3 Drug rehabilitation

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 rate of absorption, 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.

Trazodone has been shown to be effective in bulimia, kleptomania, diabetic neuropathy pain 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

Not to 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, oral candidiasis, 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

Inside . 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. Alcohol should be avoided during the treatment period.

Use with caution during work for drivers of vehicles and people whose activities are associated with increased concentration of attention.

Brand names with the active ingredient Trazodone

Reset filters

Lek. form
All lek. sustained-release tablet forms controlled-release tablets sustained-release tablets

Dosage
All dosages 150 mg 75 mg

Manufacturer
Aziende Kimike Riunite Angelini Francesco A. K.R.A.F. S.p.A.

Trittiko long-release enteric tablets 150mg №20

S.P.A.

Prescription

Yes

Active ingredient

trazodone

Shelf life

3 years

Storage conditions

At a temperature not exceeding 25C. Keep out of the reach of children!

Online sale

No

Contraindicated. Specialist consultation required

Overview

Composition

One extended-release tablet contains:

Active ingredient: trazodone hydrochloride 150.0 mg.

Excipients: sucrose 84.0 mg, carnauba wax 24.0 mg, povidone 24.0 mg, magnesium stearate 6.0 mg.

Dosage form

Long-acting tablets.

Description

White or white with a yellowish tinge, oval-shaped biconvex tablets with two parallel notches on both sides.

Pharmacodynamics

Pharmacodynamics: trazodone inhibits neuronal reuptake of serotonin, is a 5-HT antagonist -adrenergic receptors and has an antidepressant effect.

Pharmacokinetics

Absorption of trazodone from the gastrointestinal tract after oral administration is high. Taking trazodone during or immediately after a meal slows down the absorption rate, reduces the maximum concentration of trazodone in the blood plasma and increases the time to reach the maximum concentration (TC _max ).

TC _{max achieved 1/2-2 hours after ingestion.}

Trazodone crosses blood-tissue barriers into tissues and fluids (bile, saliva, breast milk).

Communication with plasma proteins 89 – 95%.

Trazodone is metabolized in the liver, the active metabolite is 1-m-chlorophenylpiperazine. The half-life is 3-6 hours, in the second phase 5-9 hours. The excretion of most of the metabolized trazodone is carried out by the kidneys with urine – about 75%, and is completely completed 98 hours after ingestion, about 20% is injected with bile. In vitro studies on human microsomes have shown that trazodone is mainly metabolized by the cytochrome P450 isoenzyme (CYP3A4 isoenzyme).

Indications for use

Depression with or without anxiety.

Contraindications

Symptoms: drowsiness, dizziness, nausea, vomiting. In more severe cases, coma, tachycardia, hypotension, hyponatremia, convulsions and respiratory failure. Dysfunction of the cardiovascular system (prolongation of the QT interval, bradycardia). After an overdose, symptoms may appear within 24 hours or more.

Treatment: There is no specific antidote for trazodone. In cases of overdose, it is necessary to wash the stomach and prescribe activated charcoal within 1 hour after taking the overdose. Carry out symptomatic and supportive treatment.

Pregnancy and lactation

Not recommended for pregnant women. The drug is not recommended for use during breastfeeding.

Side effects

Trittico may cause side effects, although not everyone gets them.

From the blood and lymphatic system: agranulocytosis, thrombocytopenia, eosinophilia, leukopenia and anemia,

From the immune system: allergic reactions,

From the endocrine system: syndrome of inappropriate secretion of antidiuretic hormone (SNS ADH), hallucinations,

From the nervous system: epileptic seizures, dizziness, headache, insomnia or drowsiness, amnesia, tremor, convulsions, paresthesia, taste disturbance,

From the side of the cardiovascular system: palpitations, tachycardia, bradycardia, ventricular extrasystoles, ventricular paroxysmal tachycardia, prolongation of the QT interval, increased blood pressure (BP), lowering blood pressure, syncope,

From the gastrointestinal tract: 900 64 nausea, vomiting, dry mouth, dyspepsia, abdominal pain, diarrhea, increased salivation, paralytic ileus,

From the skin and subcutaneous tissues: itching, erythematous rash, sweating,

Musculoskeletal and connective tissue disorders: myalgia, arthralgia,

Kidney and urinary tract disorders: urination disorders, nye, who have this side effect, you should immediately stop taking the drug and consult a doctor),

Other: fatigue, weakness, fever, flu-like syndrome.

Interactions

Trazodone may potentiate the effects of some antihypertensive drugs and usually require dose reduction.

Simultaneous use with drugs that depress the central nervous system (including clonidine, methyldopa) enhances the effect of the latter.

H2-histamine receptor blockers and drugs with m-anticholinergic activity enhance the m-anticholinergic effect of trazodone.

Trazodone enhances and prolongs the sedative and m-anticholinergic effects of tricyclic antidepressants, haloperidol, loxapine, maprotiline, phenothiazine, pimozidane and thioxanthine.

Co-administration of tricyclic antidepressants and trazodone may cause cardiovascular side effects.

MAO inhibitors increase the risk of side effects.

When used together, it increases the concentration of digoxin and phenytoin in the blood plasma.

In vitro studies of drug metabolism indicate the possibility of pharmacological interactions of trazodone with inhibitors of the cytochrome P450 isoenzyme (CYP3A4 isoenzyme), such as ketoconazole, ritonavir, indinavir and fluoxetine. Inhibitors of the CYP3A4 isoenzyme can lead to a significant increase in plasma concentrations of trazodone, thereby increasing the likelihood of adverse events. Therefore, when taken in combination with potent inhibitors of the CYP3A4 isoenzyme, the dose of trazodone should be reduced. When taking trazodone in combination with carbamazepine, the plasma concentration of trazodone decreases. Therefore, patients taking concomitant trazodone and carbamazepine should be closely monitored.

Dosage and Administration

Tablets should be taken orally 30 minutes before a meal or 2 to 4 hours after a meal. Tablets should be taken whole, without chewing, and with plenty of water.

Starting dose of : 100 mg taken once at bedtime after meals. On the 4th day, you can increase the dose to 150 mg. Further dose increases in order to achieve the optimal therapeutic effect should be made by 50 mg / day every 3-4 days until the optimal dose is reached. A daily dose of more than 150 mg should be divided into 2 doses, with a smaller dose taken after dinner, and the main one at bedtime.

Maximum daily dose for outpatients 450 mg.

Maximum daily dose for inpatients. 600 mg.

Elderly and debilitated patients Initial dose up to 100 mg/day in divided doses or once at bedtime. It can be increased under the supervision of a physician, depending on the effectiveness and tolerability of the drug. Doses in excess of 300 mg/day are usually not required.

Overdose

Symptoms: drowsiness, dizziness, nausea, vomiting. In more severe cases, coma, tachycardia, hypotension, hyponatremia, convulsions and respiratory failure. Dysfunction of the cardiovascular system (prolongation of the QT interval, bradycardia). After an overdose, symptoms may appear within 24 hours or more.

Treatment: There is no specific antidote for trazodone. In cases of overdose, it is necessary to wash the stomach and prescribe activated charcoal within 1 hour after taking the overdose. Carry out symptomatic and supportive treatment.

Warnings

Suicide/suicidal ideation or worsening of clinical symptoms: Depressive states are at increased risk of suicidal thoughts, self harm or suicide. The risk may last until a pronounced remission occurs. Since improvement may not occur during the first few weeks of treatment or more, patients should be closely monitored until such improvement occurs. According to general clinical experience, the risk of suicide may increase in the early stages of recovery. Patients with a history of suicidal events, or patients who exhibit a significant degree of suicidal ideation prior to treatment, are known to be at higher risk of suicidal thoughts or suicide attempts and should be closely monitored during treatment. The results of a meta-analysis of placebo-controlled clinical trials of antidepressants used in adults with mental disorders showed an increased risk of developing suicidal behavior in patients younger than 24 years of age while taking antidepressants compared with placebo. Careful monitoring of patients, especially those at high risk, should accompany drug therapy, especially in the early stages and after dose changes. Patients (and their caregivers) should be warned to watch for any clinical deterioration, suicidal behavior or suicidal thoughts, unusual changes in behavior, and seek immediate specialist advice if such symptoms occur.

Since the drug has some adrenoblocking activity, it is possible to develop bradycardia and lower blood pressure. Therefore, caution should be exercised when prescribing the drug to patients with a tendency to prolong the QT interval, atrioventricular blockade of varying severity, and patients with a recent myocardial infarction. When treated with trazodone in patients with bipolar disorder, depressive episodes can range from manic-depressive to manic psychosis. In these cases, it is necessary to interrupt treatment.

In epilepsy, trazodone should be used with caution, in particular avoiding sudden dose increases or decreases. With the simultaneous use of trazodone with drugs with serotonergic activity (tricyclic antidepressants, selective serotonin reuptake inhibitors, norepinephrine and serotonin reuptake inhibitors and monoamine oxidase inhibitors) and neuroleptics, serotonin syndrome may occur. With the simultaneous use of trazodone with preparations containing St. John’s wort, side effects may be more frequent.

Agranulocytosis may develop with trazodone, therefore it is recommended to conduct peripheral blood tests, especially in the presence of pain in the throat when swallowing and the appearance of fever.

Trazodone is effective in sleep disorders in patients with depression, increases the depth and duration of sleep, restores its physiological structure and quality. The use of the drug does not affect body weight.

The drug is not addictive.

Influence on the ability to drive vehicles and control mechanisms

During the period of use of the drug Tritgico, care must be taken when driving vehicles and engaging in other potentially hazardous activities that require increased concentration and speed of psychomotor reactions.