What to Know About Trazodone

An Antidepressant Used to Treat Depression and Sleep Disorders

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

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

Woman looking out of window may have anxiety, depression, insomnia
Robin Gentry / EyeEm / Getty Images

Uses

Trazodone is used to control depression symptoms but cannot cure depression. Your doctor may start you at a low dose and gradually increase it every few days. 

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

Before Taking

Before this drug is prescribed for depression, your doctor will determine if the possible benefits outweigh the risks. Trazodone has a long list of drugs that may cause interactions. Talk to your doctor 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 as to whether the pros of treatment outweigh the cons in your case.

Before trazodone is prescribed to people who are pregnant or breastfeeding, their doctor may explore other treatment options with fewer side effects. 

Precautions and Contraindications

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

This is very distressing, and it is important to remember that it is being caused by the medication. These thoughts are rare, but usually occur during the first two weeks of treatment, so staying in close contact with your doctor and mental health provider is crucial.

Your doctor 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. This is an irregular heart rhythm that worsens with trazodone and 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 doctor may check those levels before prescribing trazodone. 

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

Other Antidepressants 

In addition to trazodone, the most common antidepressants include:

Dosage

Trazodone is available in both a 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 trazodone tablets, a normal starting dose is 150 milligrams (mg) per day in two divided doses. This would most likely look like taking 75 mg in the morning and 75 mg at night.

Your doctor will then work with you to find the right dose by increasing the milligrams 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 as they can cause drowsiness and should never be chewed or crushed.

Your doctor may increase the 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 doctor to make sure you are taking the right dose for you.

How to Take and Store

Your doctor will probably recommend taking a trazodone tablet with a meal or snack to prevent stomach upset. If you are prescribed the extended-release tablet, on the other hand, it should be taken at night on an empty stomach. 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

Most common side effects of Trazodone are mild and do not require a change in dosing or prescription. Common side effects include:

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

Severe

Because of Trazodone’s effect on your mood and heart function, certain side effects must be addressed right away. Call your doctor 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 even death. Symptoms of an overdose may include:

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

If you or your child experience any overdose symptoms, call the Poison Center immediately.

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 black box 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 doctor 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. This is hard to talk about, so remember that addressing it imperfectly is better than ignoring it. 

When taken with other antidepressants, trazodone could cause serotonin syndrome. This happens when there is too much serotonin in your body. You could experience shivering, diarrhea, fever, seizures, and loss of consciousness. If you notice the early symptoms of shivering and diarrhea, talk with your doctor right away. 

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

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Article Sources
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