Trazodone Medication Guide

Active Ingredient

Trazodone hydrochloride is the active ingredient in Trazodone. It primarily functions as a serotonin antagonist and reuptake inhibitor (SARI), affecting chemical messengers in the brain.

Pharmacokinetics

Trazodone is well-absorbed from the gastrointestinal tract. Peak plasma concentrations are typically achieved within 1 to 2 hours post-administration. It undergoes extensive hepatic metabolism, primarily by the enzyme CYP3A4. The half-life of trazodone ranges from 5 to 13 hours. It is eliminated via both renal and fecal routes.

Indications for Use

Trazodone is primarily prescribed for the treatment of major depressive disorder (MDD). It may also be used off-label for treatment of anxiety disorders, insomnia, and certain types of pain such as neuropathic pain. The efficacy in these conditions varies and is dependent on individual patient response.

Dosage Forms

Trazodone is available in several dosage forms including immediate-release tablets and extended-release tablets. Common dosages for immediate-release tablets are 50 mg, 100 mg, 150 mg, and 300 mg. Extended-release dosages commonly available are 150 mg and 300 mg tablets.

Administration Guidelines

Immediate-release trazodone should be taken shortly after a meal or light snack to enhance absorption and reduce gastrointestinal discomfort. Extended-release trazodone should be taken on an empty stomach, typically 2 hours after a meal, to ensure optimal absorption. It is advisable to take trazodone at bedtime due to its sedative effects.

Common Side Effects

Frequently reported side effects include dizziness, sedation, headache, nausea, dry mouth, and blurred vision. These effects may diminish as the body adjusts to the medication. A significant drop in blood pressure, particularly upon standing, is also a common effect and may require monitoring.

Severe Side Effects

Serotonin syndrome, a potentially life-threatening condition manifested by symptoms such as hallucinations, agitation, rapid heart rate, and increased body temperature, can occur particularly when combined with other serotonergic drugs. Priapism, a prolonged and painful erection, can occur and requires immediate medical attention to prevent potential complications.

Drug Interactions

Trazodone can interact with several classes of medications, including MAO inhibitors, other antidepressants, antipsychotics, and certain antibiotics. Concomitant use with alcohol and CNS depressants can amplify sedative effects. Grapefruit juice can also affect trazodone metabolism, leading to increased blood levels of the drug.

Special Populations

Dose adjustments may be necessary for elderly patients and those with hepatic or renal impairment. Pregnant and breastfeeding women should only use trazodone if the potential benefits justify the potential risks to the fetus or infant. Pediatric use is not well-established.

Mental Health Impact

Clinical studies have shown trazodone’s impact on reducing depressive symptoms by improving sleep quality and overall mood. It is particularly noted for its sedative effects, which can be beneficial for patients suffering from insomnia related to depression.

Mechanism of Action

Trazodone primarily works by inhibiting the reuptake of serotonin, thereby increasing its levels in the brain. It also antagonizes certain serotonin receptors, contributing to its antidepressant and anxiolytic effects. The sedative properties are largely attributed to alpha-1 adrenergic receptor blockade.

Storage Conditions

Trazodone should be stored at room temperature, away from moisture and heat. It should be kept in a tightly closed container, out of reach of children. Extended-release tablets should be protected from light.

Missed Dose Instructions

If a dose of trazodone is missed, it should be taken as soon as remembered unless it is close to the time for the next dose. In such cases, the missed dose should be skipped, and the regular dosing schedule resumed. Doubling up doses can increase the risk of side effects.

Discontinuation Process

Trazodone should not be abruptly discontinued without consulting a healthcare provider due to the risk of withdrawal symptoms. A gradual tapering schedule may be recommended to minimize discontinuation effects such as anxiety, agitation, and rebound insomnia.

Patient Monitoring

Patients on trazodone should undergo regular monitoring for therapeutic response and side effects. Blood pressure should be checked periodically due to the risk of orthostatic hypotension. Mental health evaluations may be conducted to assess for symptom improvement or worsening depression.

Long-term Use Considerations

Long-term treatment with trazodone may require periodic reassessment. The benefits must be weighed against potential risks such as weight gain and metabolic changes. Patients should be educated about the possibility of increased appetite and advised on nutritional and lifestyle modifications if necessary.

Preparation for Surgery

Patients scheduled for surgery should notify their surgeon and anesthesiologist about trazodone use. Trazodone can interact with anesthetics and other perioperative medications, which may necessitate temporary discontinuation or dosage adjustment.

Alcohol Consumption

Concurrent use of alcohol with trazodone is generally advised against due to additive effects on the central nervous system. Consuming alcohol while on trazodone can significantly increase the risk of sedation, dizziness, and impairment of motor skills.

Overdose Management

In cases of suspected trazodone overdose, immediate medical attention is necessary. Symptoms of overdose can include extreme drowsiness, vomiting, prolonged erection, and respiratory distress. Activated charcoal and symptomatic treatments may be employed in hospital settings.

Educational Needs

Patients should be instructed on recognizing early signs of severe side effects and the importance of adherence to prescribed dosages. Educational materials may include pamphlets, counseling sessions, and app-based reminders for dosage timings.