Side Effects, Dosage, Uses, and More

This drug has a black box warning. This is the most serious warning from the Food and Drug Administration (FDA). A black box warning alerts doctors and patients about drug effects that may be dangerous.

Drugs used to treat depression, including trazodone, may cause an increase in suicidal thoughts or actions. This risk is higher in children, teenagers, or young adults. It’s also higher within the first few months of treatment with this drug or during dosage changes. You and your family members, caregivers, and doctor should watch for any new or sudden changes in your mood, behaviors, thoughts, or feelings. Trazodone is not approved for use in pediatric patients. Call your doctor right away if you notice any changes.

1. Trazodone oral tablet is available as a generic drug. It doesn’t have a brand-name version.
2. Trazodone only comes as a tablet you take by mouth.
3. Trazodone is used to treat depression.

Trazodone oral tablet is a prescription drug. It’s available only as a generic drug. Generic drugs usually cost less than brand-name drugs.

Why it’s used

Trazodone is used to treat depression in adults.

How it works

Trazodone belongs to a class of drugs called antidepressants. A class of drugs is a group of medications that work in a similar way. These drugs are often used to treat similar conditions.

It isn’t fully understood how trazodone works. It may increase serotonin activity in your brain. Serotonin is a chemical in your brain that can help stabilize your mood.

Trazodone oral tablet may cause drowsiness or sleepiness. You shouldn’t drive, use machinery, or do other activities that require alertness until you know how this drug affects you.

Trazodone can cause mild or serious side effects. The following list contains some of the key side effects that may occur while taking trazodone. This list does not include all possible side effects.

For more information on the possible side effects of trazodone, or tips on how to deal with a troubling side effect, talk with your doctor or pharmacist.

More common side effects

The more common side effects of trazodone can include:

• swelling
• sleepiness
• dizziness
• diarrhea
• stuffy nose
• weight loss
• blurred vision

These effects may go away within a few days or a couple of weeks. If they’re more severe or don’t go away, talk to your doctor or pharmacist.

Serious side effects

Call your doctor right away if you have serious side effects. Call 911 if your symptoms feel life threatening or if you think you’re having a medical emergency. Serious side effects and their symptoms can include the following:

• Thoughts of suicide and worsening depression. Symptoms include:
  • thoughts about suicide or dying
  • attempts to die by suicide
  • new or worse depression
  • new or worse anxiety
  • feeling very agitated or restless
  • panic attacks
  • insomnia (trouble sleeping)
  • new or worse irritability
  • acting aggressive, angry, or violent
  • acting on dangerous impulses
  • mania (an extreme increase in activity and talking)
  • other unusual changes in behavior or mood
• Serotonin syndrome. Symptoms include:
  • agitation
  • confusion or trouble thinking
  • hallucinations (seeing or hearing something that isn’t there)
  • problems with coordination
  • fast heart rate
  • tight muscles
  • trouble walking
  • nausea
  • vomiting
  • diarrhea
• Vision problems. Symptoms include:
  • eye pain
  • changes in your vision, such as blurred vision or visual disturbances
  • swelling or redness in or around your eye
• Irregular or fast heartbeat
• Low blood pressure. Symptoms include:
  • dizziness or fainting when you change positions, such as standing up from a sitting position
• Unusual bruising or bleeding
• Erection that lasts longer than 4 hours
• Hyponatremia (low sodium in your blood). Symptoms include:
  • headache
  • weakness
  • confusion
  • trouble concentrating
  • memory problems
  • feeling unsteady when you walk

Suicide prevention

1. If you think someone is at immediate risk of self-harm or hurting another person:
2. • Call 911 or your local emergency number.
3. • Stay with the person until help arrives.
4. • Remove any guns, knives, medications, or other things that may cause harm.
5. • Listen, but don’t judge, argue, threaten, or yell.
6. If you or someone you know is considering suicide, get help from a crisis or suicide prevention hotline. Try the National Suicide Prevention Lifeline at 800-273-8255.

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The trazodone dosage your doctor prescribes will depend on various factors. These include:

• the type and severity of the condition you’re using the drug to treat
• your age
• the form of the drug you take
• other medical conditions you may have

Typically, your doctor will start you on a low dosage and adjust it over time to reach the dosage that’s right for you. They’ll ultimately prescribe the smallest dosage that provides the desired effect.

The following information describes dosages that are commonly used or recommended. However, be sure to take the dosage your doctor prescribes for you. Your doctor will determine the best dosage to suit your needs.

Forms and strengths

Generic: Trazodone

• Form: oral tablet
• Strengths: 50 mg, 100 mg, 150 mg, 300 mg

Dosage for major depressive disorder

Adult dosage (ages 18 years and older)

• Typical starting dosage: 150 mg per day in divided doses.
• Dosage increases: Your doctor may increase your dose by 50 mg per day every 3 or 4 days.
• Maximum dosage: 400 mg per day in divided doses. If you’re staying in a hospital, the maximum dosage is 600 mg per day.

Child dosage (ages 0–17 years)

This drug hasn’t been studied in children. It shouldn’t be used in people younger than 18 years old.

Trazodone oral tablet is used for long-term treatment. It comes with serious risks if you don’t take it as prescribed.

If you stop taking the drug or don’t take it at all. If you stop taking this drug suddenly or don’t take it, your depression may not get better. You may also have withdrawal symptoms. These include anxiety, agitation, and trouble sleeping. If you need to stop taking this drug, your doctor will slowly lower your dose over time.

If you miss doses or don’t take the drug on schedule. Your medication may not work as well or may stop working completely. For this drug to work well, a certain amount needs to be in your body at all times.

If you take too much. You could have dangerous levels of trazodone in your body. Symptoms of an overdose of this drug can include:

• an erection that lasts longer than 4 hours
• seizures
• changes in the way your heart functions, including QT prolongation (a heart rhythm issue that may cause chaotic or abnormal heartbeats)

If you think you’ve taken too much of this drug, call your doctor or seek guidance from the American Association of Poison Control Centers at 800-222-1222 or through their online tool. But if your symptoms are severe, call 911 or go to the nearest emergency room right away.

What to do if you miss a dose. Take your dose as soon as you remember. But if you remember just a few hours before your next scheduled dose, take only one dose. Never try to catch up by taking two doses at once. This could result in dangerous side effects.

How to tell if the drug is working. You should have decreased feelings of depression, and your mood should improve.

This drug comes with various warnings.

FDA warning: Suicide risk warning

• Trazodone has a boxed warning. This is the most serious warning from the Food and Drug Administration (FDA). A boxed warning alerts doctors and patients about drug effects that may be dangerous.
• Drugs used to treat depression, including trazodone, may cause an increase in suicidal thoughts or actions. This risk is higher in children, teenagers, or young adults. It’s also higher within the first few months of treatment with this drug or during dosage changes. You and your family members, caregivers, and doctor should watch for any new or sudden changes in your mood, behaviors, thoughts, or feelings. Call your doctor right away if you notice any changes.
• Trazodone is not approved for use in pediatric patients

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Serotonin syndrome warning

This drug can cause a life threatening condition called serotonin syndrome. This risk is higher when you first start taking this drug or during dosage changes.

Your risk may be higher if you also take other drugs that have similar effects as trazodone, such as other drugs used to treat depression.

Symptoms of serotonin syndrome include agitation, hallucinations, confusion or trouble thinking, nausea, vomiting, and diarrhea.

They also include coordination problems, muscle twitching, stiff muscles, racing heart rate, high or low blood pressure, sweating, fever, and coma.

Call your doctor right away if you have these symptoms.

Angle-closure glaucoma warning

This drug can cause your pupils to be slightly bigger and lead to angle-closure glaucoma (a condition that causes increased pressure in your eyes). If you’re at high risk for this condition, your doctor may give you a medication to help prevent it.

Bleeding warning

Taking this drug with other medications that affect your ability to stop bleeding may increase your risk for bleeding. This includes serious, life threatening bleeding, and bleeding-related events, such as nosebleeds, bruising, or skin discoloration due to bleeding below your skin.

These drugs include warfarin, dabigatran, rivaroxaban, and pain medications called nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and aspirin.

Allergy warning

Trazodone can cause a severe allergic reaction. Symptoms can include:

• trouble breathing
• swelling of your face, tongue, eyes, or mouth
• rash, hives (itchy welts), or blisters, alone or with fever or joint pain

If you have an allergic reaction, call your doctor or local poison control center right away. If your symptoms are severe, call 911 or go to the nearest emergency room.

Don’t take this drug again if you’ve ever had an allergic reaction to it. Taking it again could be fatal (cause death).

Alcohol interaction warning

Consuming drinks that contain alcohol can increase your risk for sleepiness or dizziness from trazodone. If you drink alcohol, talk to your doctor about whether alcohol use is safe for you while you take this drug.

Warnings for people with certain health conditions

For people with heart disease. Ask your doctor whether this drug is safe for you. Taking trazodone may cause irregular heartbeat and a prolonged QT interval (a heart rhythm issue that may cause chaotic or abnormal heart beats). Your doctor may watch you closely if you take this drug.

For people with angle-closure glaucoma. This drug may make your pupils bigger and may cause an angle-closure attack.

For people with a history of mania or bipolar disorder. You may have a higher risk for manic episodes. If you have a history of mania or bipolar disorder, your doctor may need to prescribe a different medication.

Warnings for other groups

For pregnant women. There haven’t been enough studies done in humans to be certain how this drug might affect a pregnancy.

Research in animals has shown negative effects to the fetus when the mother takes this drug. However, animal studies don’t always predict the way humans would respond.

Talk to your doctor if you’re pregnant or planning to become pregnant. This drug should only be used if the potential benefit justifies the potential risk to the fetus. Call your doctor right away if you become pregnant while taking this drug.

There’s a pregnancy exposure registry that monitors pregnancy outcomes in women exposed to antidepressants during pregnancy. To take part in the National Pregnancy Registry for Antidepressants, call 844-405- 6185 or visit their website.

Women who are breastfeeding. Trazodone may pass into breast milk and may cause side effects in a child who is breastfed. Talk to your doctor if you breastfeed your child. You may need to decide whether to stop breastfeeding or stop taking this medication.

For seniors. The kidneys of older adults may not work as well as they used to. This can cause your body to process drugs more slowly. As a result, more of a drug stays in your body for a longer time. This raises your risk of side effects.

If you’re over the age of 65 years, you may be at higher risk for developing side effects while taking this drug. This includes hyponatremia (low salt levels in your blood).

For children. The safety and effectiveness of this drug haven’t been established in children. This drug shouldn’t be used in people younger than 18 years.

Trazodone oral tablet can interact with several other medications. Different interactions can cause different effects. For instance, some can interfere with how well a drug works, while others can cause increased side effects.

Below is a list of medications that can interact with trazodone. This list does not contain all drugs that may interact with trazodone.

Before taking trazodone, be sure to tell your doctor and pharmacist about all prescription, over-the-counter, and other drugs you take. Also tell them about any vitamins, herbs, and supplements you use. Sharing this information can help you avoid potential interactions.

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Drugs you should not use with trazodone

Do not take these drugs with trazodone. Doing so can cause dangerous effects in your body. Examples of these drugs include:

• Monoamine oxidase inhibitors (MAOIs), such as isocarboxazid, phenelzine, tranylcypromine, or selegiline. You shouldn’t take trazodone with MAOIs or within 14 days of taking them. Taking these drugs together raises your risk for serotonin syndrome.

Interactions that can cause more side effects

Taking trazodone with certain medications may cause more side effects. These drugs include:

• Central nervous system (CNS) depressants such as pentobarbital and secobarbital. Trazodone may make your response to barbiturates and other CNS depressants stronger.
• Warfarin. Taking trazodone with warfarin can increase your risk for bleeding. Your doctor will watch you closely.
• Nonsteroidal anti-inflammatory drugs (NSAIDs) or aspirin. Trazodone may increase your risk of bleeding when used with these drugs.
• Depression drugs, such as citalopram, fluoxetine, paroxetine, sertraline, venlafaxine, duloxetine, and St. John’s wort. Taking these drugs together may increase your risk of serotonin syndrome. This condition can be life threatening.
• Digoxin. Taking trazodone with digoxin may increase the levels of digoxin in your body. This could increase your risk of side effects from digoxin. These include vomiting, dizziness, vision problems, and irregular heart rate. Your doctor may monitor the level of digoxin in your blood if you take these drugs together.
• Phenytoin. Taking trazodone with phenytoin may increase the levels of phenytoin in your body. This could increase your risk for side effects from phenytoin. These include constipation, changes in mood, confusion, and balance problems. Your doctor may monitor the level of phenytoin in your blood if you take these drugs together.
• Ketoconazole or ritonavir. The level of trazodone in your body may increase if you take it with ketoconazole, ritonavir, or other drugs that increase levels of trazodone. This can increase your risk of side effects from trazodone. These include serotonin syndrome and vision problems. Your doctor may lower your trazodone dosage if you take drugs that can increase trazodone levels.

Interactions that can make drugs less effective

Certain drugs may decrease the levels of trazodone in your body and make your dosage of trazodone less effective. You doctor may need to increase your dosage of trazodone when you take it with these drugs.

These drugs include:

• Phenytoin and carbamazepine

Keep these considerations in mind if your doctor prescribes trazodone oral tablet for you.

General

• Take trazodone shortly after a meal or snack.
• You should swallow this drug whole. You can also break it in half along the score line (indented line down the center of the tablet) and swallow it. Don’t chew or crush trazodone tablets.

Storage

• Store trazodone at room temperature. Keep it between 68°F and 77°F (20°C and 25°C).
• Keep it away from light.

Refills

A prescription for this medication is refillable. You should not need a new prescription for this medication to be refilled. Your doctor will write the number of refills authorized on your prescription.

Travel

• Always carry your medication with you. When flying, never put it into a checked bag. Keep it in your carry-on bag.
• Don’t worry about airport X-ray machines. They can’t hurt your medication.
• You may need to show airport staff the pharmacy label for your medication. Always carry the original prescription-labeled box with you.
• Don’t put this medication in your car’s glove compartment or leave it in the car. Be sure to avoid doing this when the weather is very hot or very cold.

Clinical monitoring

You and your doctor should monitor certain health issues. This can help make sure you stay safe while you take this drug. These issues include:

• Eye health. You may be at risk for angle-closure glaucoma. Your doctor may do an eye exam and treat you if needed.
• Mental health and behavioral problems. You and your doctor should watch for any changes in your behavior and mood. This drug can cause new mental health and behavior issues. It can also make problems you already have worse.

Prior authorization

Many insurance companies may require a prior authorization for this drug. This means your doctor will need to get approval from your insurance company before your insurance company will pay for the prescription.

There are other drugs available to treat your condition. Some may be better suited for you than others. Talk to your doctor about other drug options that may work for you.

Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up-to-date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.

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 the 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), type 5 phosphodiesterase inhibitors, adaptogens, as well as multiple sessions of rational and suggestive psychotherapy, the failure expectation neurosis 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.

1. NIH Consensus Conference. Impotence. NIH round table on consensus building on impotence. JAMA, 1993; 270: 83-90

2. Litvin M.S., Nid R.J., Dhanani N. The impact of health status on quality of life in men with erectile dysfunction. Journal of General Medicine of Internal Diseases, 1998; 13: 159-66

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

4 . Johannes CB, Araujo AB, Feldman HA, Derby CA, Kleinman KP, McKinlay JB.

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

Massachusetts male aging study. J Urol 2000;163(2):460-3. PMID: 10647654

5. Feldman H. A., Goldstein I., Hatzichristou D. G. et al. Impotence and its medical ad psychosocial correlates: results of the Massachusetts Male Aging Study. J. Urol. (Baltimore) 1994; 151:54-61.

6. Pushkar D.Yu. Rasner P.I. Drug treatment of erectile dysfunction: a preliminary comparison of existing methods. Pharmateka. 2004. No. 3/4. C. 1-4.

7. Lizza E.F., Rosen R.C. Definition and classification of erectile dysfunction: Report of the Nomenclature Committee of the International Society of Impotence Research. // Int J Impot Res – 1999.

8. Lance R., Apbo M., Kostable R. A., Stears W. D. Oral trazodone as empiric treatment for erectile dysfunction: a retrospective review. Urology, 1995; 46: 117-20

9. Erdpi I. New oral therapies for the treatment of erectile dysfunction. British Journal of Urology, 1998; 81: 122-7

10. Krege S., Göpel M. , Sperling G., Michel M. K. Affinity of trazodone for α1-α2 adrenoceptors of the penis in humans. BJU Int, 2000; 85: 959-61

11. . A. Fink, R. McDonald, I. R. Rootks, and T. J. Wilt. Trazodone as a treatment for erectile dysfunction: a systematic review and meta-analysis Minneapolis, USA. BJU International, 2003.

12. Kurt U., Ozkardes G., Altug U., Germiyanoglu J., Gurdal M., Erol D. Effectiveness of antiserotonergic substances in the treatment of erectile dysfunction. Journal of Urology, 1994; 152: 407-9

13. Montorsi F., Strumbi L. F., Guazzoni G. and colleagues. The effect of yogimbin-trazodone on psychogenic impotence: a randomized, double-blind, placebo-controlled study. Urology, 1994; 44: 732-6

14. Kostabile R.A., Spevak M. Oral trazodone is not effective for erectile dysfunction: a double-blind, placebo-controlled study. Journal of Urology, 1999; 161: 1819-22

15. Tkachuk V. N., Lukyanov A.E. The effectiveness of the drug “Trittico” in the treatment of erectile dysfunction of psychogenic origin. Abstracts of the conference “Men’s Health” Moscow, 2006

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

Contents

• Structural formula

• Russian name

• English title

• 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.