What to Know About Trazodone

Trazodone is an antidepressant in the serotonin modulators class of drugs. It is used to treat depression and works by increasing the action of serotonin in your brain. In addition to being used for managing depression, it can be used to treat insomnia and anxiety. 

Trazodone comes in a tablet and an extended-release tablet. Common brand names include Desyrel, Desyrel Dividose, and Oleptro.

Uses

Trazodone is used to control symptoms of depression, but it cannot cure depression. Your healthcare provider may start you at a low dose and gradually increase it. 

Trazodone increases serotonin activity in your brain. Serotonin is a chemical that normally promotes a feeling of mental wellbeing. Trazodone is also indicated for the treatment of insomnia and anxiety symptoms. 

Before Taking

Before you are prescribed this drug for the treatment of your depression, your healthcare provider will consider whether the possible benefits outweigh the risks. Trazodone may interact with many other medications. Talk to your healthcare provider about all medications, supplements, and vitamins that you currently take.

While some drugs pose minor interaction risks, others may outright contraindicate use or prompt careful consideration and/or monitoring for interactions.

If you are pregnant or breastfeeding, your healthcare provider may explore other treatment options for you besides trazodone. 

Precautions and Contraindications

Trazodone should be used with caution in teenagers and young adults. Studies have shown that a small percentage of young people under the age of 24 who take trazodone may develop suicidal ideation or thoughts of harming themselves.

Your healthcare provider will talk with you about a plan for how to contact the appropriate resources should you or your child experience thoughts of self-harm while taking trazodone.

Trazodone should not be used in patients with a history of heart disease or a recent heart attack. This drug can cause or worsen QT prolongation which can cause an irregular heart rhythm that can lead to fainting, seizures, or even death.

This heart rhythm problem is affected by the levels of potassium, sodium, and magnesium in your blood, so your healthcare provider may check those levels before prescribing trazodone. 

If you have a history of glaucoma, trazodone could worsen it. Your healthcare provider may ask you to have an eye exam before prescribing it. 

Other Antidepressants 

In addition to trazodone, the most common antidepressants include:

• Celexa (citalopram)
• Lexapro (escitalopram)
• Paxil (paroxetine)
• Prozac (fluoxetine)
• Zoloft (sertraline)

Dosage

Trazodone is available as a regular release tablet and an extended-release tablet. It is available in a generic form. According to the Food and Drug Administration (FDA), dosing should be as follows:

• For the treatment of depression, a normal starting dose is 150 milligrams (mg) per day. When the regular tablets are taken, this would most likely be scheduled as 75 mg in the morning and 75 mg at night.
• For the treatment of insomnia, the dose is usually started with 25 to 50 mg at night.

Your healthcare provider will then work with you to find the right dose and may increase your dose every few days. You may go up by 50 mg every few days, with a maximum dose of 400 mg.

According to the journal Pharmacy and Therapeutics, dosing for extended-release tablets also starts at 150 mg per day. These tablets are taken around bedtime because they can cause drowsiness.

Your healthcare provider may increase your dose by 75 mg every three days until you find the right dose for you. The maximum daily dose for extended-release tablets is 375 mg per day. 

All listed dosages are according to the drug manufacturer. Check your prescription and talk to your healthcare provider to make sure you are taking the right dose for you.

How to Take and Store

• Regular release trazodone tablets should be taken with a meal or snack to prevent stomach upset.
• If you are prescribed the extended-release tablet it should be taken on an empty stomach, and it should never be chewed or crushed.

Aim to take your prescription at the same time each day.

If you miss a dose, take it as soon as you remember. If your next dose is coming up, skip the missed dose, and never double your prescription. Because trazodone can cause drowsiness, you may need to wait until the evening to take your dose. 

It is safest to keep this medication in its original bottle with the lid tightly sealed. Make sure it is out of reach of children and kept in a cool, dry place. Rooms with heat and moisture, such as the bathroom after a shower, are not the best storage place for trazodone. 

Side Effects

Common

The most common side effects of Trazodone are mild and do not usually require a change in dosing or prescription.

Common side effects include:

• Mild dry mouth
• Unpleasant taste
• Muscle soreness
• Nausea 
• Constipation 

Severe

Because of Trazodone’s effect on your mood and heart function, certain side effects must be addressed right away.

Call your healthcare provider right away if you experience any of the following side effects:

• Suicidal thoughts
• Dizziness or lightheadedness
• Shortness of breath
• Fast or slow heartbeat 
• Confusion
• Unusual excitement or nervousness 
• Seizures

Overdose Warning

A trazodone overdose can cause serious side effects—and could be life-threatening.

Symptoms of an overdose may include:

• Loss of consciousness
• Seizures
• Shortness of breath
• Vomiting 
• Long-lasting, painful erection in men

Warnings and Interactions

Trazodone should be used with caution in patients who:

• Are adolescents with a history of suicidal thoughts
• Are pregnant
• Have a history of heart disease
• Have had a recent heart attack
• Have a history of irregular heart rhythms
• Have glaucoma
• Have certain kinds of cancer
• Have high blood pressure
• Have sickle cell anemia  
• Have liver or kidney disease

Warnings 

When used in adolescents and young adults, Trazodone comes with a boxed warning because it may cause suicidal thoughts. This side effect is rare, but it’s best to have a plan in place in the event that it does happen. Talk with your healthcare provider about changes in mood or thoughts that you should look for.

Have a list of emergency phone numbers to call for help if you notice yourself thinking of self-harm. If you are the parent of a patient taking trazodone, have honest discussions about this possibility and develop a family plan together.

When taken with other antidepressants, trazodone could cause serotonin syndrome. This happens when there is too much serotonin activity in your body. You could experience shivering, diarrhea, fever, seizures, and loss of consciousness. If you notice any of these symptoms while taking trazodone, talk with your healthcare provider right away. 

If you and your healthcare provider determine that trazodone is not a fit for you, do not stop it cold turkey, because you could experience withdrawal symptoms. Your practitioner will most likely give you a schedule for gradually reducing your dosage.