Trazodone

What Is Trazodone Used For?

Trazodone is a prescription medication that belongs to a class of drugs called serotonin antagonist and reuptake inhibitors (SARIs). At lower doses, trazodone is commonly prescribed off-label for the treatment of insomnia and sleep difficulties. At higher doses, it is FDA-approved for the treatment of major depressive disorder. Trazodone works by affecting serotonin levels in the brain, which helps promote sleep and regulate mood. When prescribed through INA for sleep, it is typically used at low doses to help you fall asleep and maintain sleep throughout the night without the dependence risk associated with some other sleep medications.

Who Is Eligible?

Trazodone may be prescribed to adults (18 and older) who experience difficulty falling asleep, staying asleep, or achieving restful sleep. Your INA provider will evaluate your sleep history, medical conditions, current medications, and mental health history to determine if trazodone is a safe and appropriate option for you. This medication may not be suitable for individuals with certain cardiac conditions, a history of serotonin syndrome, or those currently taking specific medications.

Who Should Not Use Trazodone?

Do not use Trazodone if you have any of the following conditions:

• Current use of a monoamine oxidase inhibitor (MAOI) or use of an MAOI within the past 14 days. Combining trazodone with an MAOI can cause a life-threatening reaction.
• Known hypersensitivity to trazodone or any component of the formulation
• Current use of linezolid or intravenous methylene blue (these act as MAOIs)

Warnings and Precautions

• Serotonin syndrome: Trazodone can contribute to serotonin syndrome, a potentially life-threatening condition, especially when combined with other serotonergic medications. Symptoms include agitation, hallucinations, rapid heartbeat, fever, muscle rigidity, and loss of coordination. Seek emergency care if these occur.
• Cardiac effects: Trazodone may cause cardiac arrhythmias, including QT prolongation. Use with caution if you have a history of heart disease, cardiac arrhythmias, or are taking other medications that affect heart rhythm.
• Orthostatic hypotension: Trazodone can cause a drop in blood pressure when standing up, which may lead to dizziness, lightheadedness, or fainting. Rise slowly from sitting or lying positions, especially during the first few days of treatment.
• Trazodone may cause drowsiness that persists into the next day. Do not drive or operate heavy machinery until you know how this medication affects you.
• Avoid alcohol while taking trazodone, as it can increase drowsiness and impair judgment.
• Do not stop trazodone abruptly after extended use. Your provider will guide you through a gradual dose reduction to avoid withdrawal symptoms.

Common Side Effects

The following side effects are relatively common and may improve as your body adjusts to the medication. Contact your provider if they persist or become bothersome:

• Drowsiness or sedation
• Dizziness or lightheadedness
• Dry mouth
• Headache
• Blurred vision
• Nausea
• Fatigue or feeling groggy the next morning

Serious Side Effects

• Serotonin syndrome -- agitation, hallucinations, rapid or irregular heartbeat, high fever, excessive sweating, muscle twitching or stiffness, loss of coordination, nausea, vomiting, or diarrhea
• Priapism (rare) -- a prolonged, painful erection lasting more than 4 hours that is unrelated to sexual stimulation. This is a medical emergency that requires immediate treatment to prevent permanent damage.
• Cardiac arrhythmias -- irregular heartbeat, palpitations, fainting, or chest pain
• Suicidal thoughts or behavior -- new or worsening depression, anxiety, agitation, panic attacks, insomnia, hostility, or thoughts of self-harm
• Severe allergic reaction -- rash, hives, difficulty breathing, or swelling of the face, lips, or throat
• Abnormal bleeding -- unusual bruising or bleeding, especially if taking blood thinners or NSAIDs

Drug Interactions

Tell your provider about all medications, supplements, and herbal products you are currently taking. Trazodone has significant interactions with the following:

• MAO inhibitors (phenelzine, tranylcypromine, selegiline) -- do not use within 14 days of MAOI therapy. This combination can cause serotonin syndrome.
• SSRIs and SNRIs (fluoxetine, sertraline, venlafaxine, duloxetine) -- combining with trazodone increases the risk of serotonin syndrome
• CYP3A4 inhibitors (ketoconazole, ritonavir, clarithromycin) -- these can increase trazodone blood levels and side effects
• CYP3A4 inducers (carbamazepine, phenytoin, rifampin) -- these can decrease trazodone effectiveness
• Alcohol -- increases central nervous system depression and drowsiness
• Other CNS depressants (benzodiazepines, opioids, antihistamines, muscle relaxants) -- combining may cause excessive sedation, respiratory depression, or loss of consciousness
• Digoxin and phenytoin -- trazodone may increase blood levels of these medications

Before Starting Treatment

Before beginning trazodone therapy, provide your healthcare provider with a complete medical history. This should include any history of depression, bipolar disorder, suicidal thoughts, heart disease, cardiac arrhythmias, liver or kidney disease, bleeding disorders, seizures, or a history of priapism. Inform your provider about all prescription and over-the-counter medications you are taking, especially antidepressants, anti-anxiety medications, sleep aids, pain medications, and herbal supplements such as St. John's Wort or tryptophan. If you are pregnant, breastfeeding, or planning to become pregnant, discuss the risks and benefits with your provider.

How to Use This Medication

Take trazodone by mouth as directed by your provider, typically once daily at bedtime. For sleep, it is usually taken 30 minutes before your intended bedtime. Taking it with a small snack or shortly after eating can help reduce dizziness and improve absorption. Swallow the tablet whole with water. Do not crush, chew, or break the tablet unless your provider instructs you to do so. Do not take more than the prescribed dose. If you miss a dose and it is close to the time of your next dose, skip the missed dose and continue with your regular schedule. Do not double up on doses. Store at room temperature, away from moisture and heat.

Emergency Information

If you experience signs of serotonin syndrome (rapid heartbeat, high fever, muscle rigidity, agitation), priapism (painful erection lasting more than 4 hours), suicidal thoughts, cardiac symptoms (chest pain, fainting, irregular heartbeat), or a severe allergic reaction (difficulty breathing, facial swelling), call 911 or go to your nearest emergency room immediately. If you or someone you know is in a mental health crisis, call or text the Suicide and Crisis Lifeline at 988. For non-emergency medical questions, contact your INA care team through your patient portal or email hello@tryina.com.