Trazodone

1 What is trazodone?

Brand: Oleptro and Desyrel

Generic: Trazodone

Trazodone is an atypical anti-depressant drug. Anti-depressant drugs correct the chemical imbalances in the brain that cause mood and behavior disorders. Trazodone is part of a newer class of atypical anti-depressants, which affect both norepinephrine and serotonin.

It is available in 50-, 100-, 150- and 300-mg tablets, to be taken orally.

It is also available as immediate-release and as extended-release drugs. Immediate-release, as the name suggests, is quickly dissolved upon intake and is easily absorbed into the bloodstream. However, its effects degrade just as fast. Because of the sudden change in the system, side effects may also come more drastically. On the other hand, extended-release pills are made with a coating that causes them to dissolve slowly in the body. Because it takes time for the pill to dissolve completely, its effects are more consistent as it is gradually and continuously absorbed in the bloodstream.

Trazodone is the generic name of this prescription drug. Generic drugs are commonly the preferred option as they are cheaper. However, if you are looking for branded medicine, some known trazodone brands are Oleptro and Desyrel.

2 What does trazodone treat?

Trazodone is used to treat major depressive disorder, also called clinical depression, in adults.

Depression is a psychiatric disorder characterized by feelings of intense sadness, hopelessness, and worthlessness. Some symptoms include fatigue or loss of energy, diminished interest in daily activities, insomnia or hypersomnia (excessive sleeping), significant weight loss or gain, indecisiveness, and recurring thoughts of death or suicide.

Trazodone helps improve one’s mood, energy level and even appetite. By helping restore the balance in the brain’s serotonin and norepinephrine levels, it can also decrease anxiety and insomnia that are related to depression.

While trazodone was created as treatment for depression, it has been popularly prescribed for a few off-label uses due to its effectiveness in treating other disorders, based on the experience of doctors. It is used for insomnia, obsessive compulsive disorder or OCD, schizophrenia, bulimia, and enuresis (bed-wetting) to name a few.

In combination with other drugs, trazodone is also prescribed to treat panic attacks, agoraphobia, aggressive behavior and cocaine withdrawal.

Diagnosing mental illnesses is tricky and difficult, and treating it is even more so. If you think you, a friend, or a loved one has clinical depression, consulting with a mental health specialist is an important first step.

3 What are the side effects of trazodone?

Like other anti-depressant drugs, trazodone increases the risk of suicidal thinking and behavior as it affects the chemical balances in the brain. For people aged below 24, this risk may be greater. It is important, then, that upon starting treatment with trazodone, one is carefully watched for any thoughts of suicide, or symptoms like aggression, abnormal excitement, restlessness, irritability, and panic attacks, among others. Close observation is not just the doctor’s responsibility but also that of the people around the patient on a daily basis, be it his or her family, close friends or caregiver.

Compared to other anti-depressants, trazodone is more sedating and less anti-cholinergic. When a drug is anti-cholinergic, it restricts the neurotransmitter acetylcholine from binding with its receptor nerve cells. This is associated with the involuntary movement of smooth muscles in the gastrointestinal tract, lungs, urinary tract, and other parts of the body. Anti-cholinergic drugs are linked to diminished bowel movement, urinary retention, and lack of sweat.

As every person is different, the way medication affects each person also varies. While the common side effects are listed below, it is always best to speak to your doctor about any change in your body or state of mind that troubles you, especially if you experience worse symptoms of depression. Some side effects also require medical attention, so it is important to watch your body and not dismiss anything.

Here are some major side effects that require medical attention:

  • Blurred vision
  • Confusion
  • Headache, dizziness or lightheadedness
  • Faintness, dizziness or lightheadedness when suddenly getting up from a lying or sitting position
  • Sweating
  • Unusual tiredness or weakness
  • Fainting
  • General feeling of discomfort or illness
  • Nervousness
  • Decreased concentration
  • Lack of coordination or difficulty in walking
  • Muscle tremors
  • Pounding in the ears
  • Shortness of breath
  • Slowing down or speeding up of heartbeat
  • Swelling
  • Burning, numbness, prickling, itching, crawling or tingling feelings
  • Skin rash

Here are minor side effects that do not require medical attention:

  • Drowsiness or lack of mental and physical alertness
  • Dryness of the mouth
  • Unpleasant taste
  • Muscle or bone pain
  • Weight loss
  • Constipation or diarrhea
  • Agitation
  • Trouble sleeping
  • Trouble with remembering
  • Continuing ringing or buzzing or other unexplained noise in the ears
  • Hearing loss

Despite the extensive and intimidating list of side effects linked with trazodone, it is generally well-tolerated.

If you are unsure, it is always preferred to move forward with caution. Reach out to your doctor to keep him or her up-to-date with the drug’s effects on you. It is also beneficial to ask your mental health specialist a lot of questions before taking the treatment so you are better prepared.

4 How trazodone works

Our body functions by sending messages through the thousands of connections that exist between our brain cells. These messages cross a small gap called synapse through neurotransmitters. One of these is called serotonin, which helps regulate mood, emotions, and other body functions. Serotonin crosses the synapse to deliver the message from one nerve cell to the next, and is then reabsorbed to assist in sending the next message.                     

People with depression may have imbalances in their serotonin levels, causing impairments in the way the brain and its wide network receives and sends messages.

Trazodone works by blocking the reabsorbing of serotonin so that more becomes available to the nerve cells, similar to selective serotonin reuptake inhibitors or SSRIs. This is another type of antidepressant. Because of the similarity, trazodone is commonly thought to be an SSRI. But unlike SSRIs, trazodone may also block serotonin receptors as well as other receptors. This process helps restore serotonin back to its normal levels, lifting the common debilitating symptoms of depression and allowing a person to function normally.

However, it is difficult to say how trazodone works because, although it shares many similarities with other antidepressants, nothing works exactly like it either. In addition to that, while it is said that depression is linked to low levels of serotonin, science can only measure serotonin levels in the blood and it cannot be assumed that the blood serotonin levels is just the same as the levels in the brain. So, as there is still debate and different perspectives on what depression really is and what causes is, there is also mystery in the exact mechanism of antidepressants.

It is also important to note that trazodone does not cause euphoria, so this medicine is not addictive or habit-forming. On the contrary, because of its sedative effects, instead of experiencing a high, one would only feel sleepy. This makes trazodone a good option for people with depression  who also have a history of addiction.

When taking trazodone daily to treat depression, it could take anywhere from one to three weeks before noticeable effects can be observed or felt. Although, this varies from person to person and not all anti-depressant medicines will work on everyone. So if your doctor prescribed trazodone and you do not feel immediate improvement, continue taking the drug for the prescribed period. At the very least, discuss with your doctor before deciding to cease treatment.

However, if trazodone is taken to cure insomnia or other sleep disorders, it could take only one to three hours to take effect.

5 Trazodone dosage

Generally, the following are dosage guidelines for trazodone.

Immediate-release tablets for adults with depression:

  • Initial Dose: 150 mg per day, in divided doses
  • Maintenance Dose: Increase by 50 mg per day every three to four days
  • Maximum dose for outpatients is usually 400 mg per day, in divided doses

The trazodone immediate-release tablet should not be taken on an empty stomach. It should be swallowed whole shortly after a meal or a light snack. Do not crush, break or chew an extended-release tablet.

For extended-release tablets:

  • Initial Dose: 150 mg, once a day
  • Maintenance Dose: Increase by 75 mg per day every three to four days
  • Maximum dose for outpatients is usually 375 mg

The extended-release pill should be taken on an empty stomach at the same time daily, preferably at bedtime or late in the evening. If necessary, the tablet can be divided into two along the half line.

Elderly and debilitated patients may require lower doses.

Trazodone has not been approved for use for children. Typically, the risks for children and adolescents with the clinical need for the drug outweigh the benefits, and other drugs or methods of treatment are recommended by a doctor.

For treatment of insomnia, the prescribed dosage ranges from 25 to 75 mg.

However, your medication dosage and treatment plan is affected by several factors including your age and weight, other conditions that you may have, and other medications that you are currently taking. Your doctor will take these into consideration and prescribe the appropriate dosage for your treatment to ensure that you are getting the best results.

Follow the directions on your prescription religiously.

  • If you missed a dose, take it as soon as you remember. If it is almost time for the next dose, take the next schedule dose and skip the missed one. Do not take an extra dose to make up for the one you missed.
  • The doctor may prescribe smaller dosages at the beginning of the treatment to minimize the risk of side effects. Additionally, he or she may adjust the dosage in the middle of treatment as best fits your situation.
  • Do not take larger or smaller amounts or for longer than prescribed by the doctor.
  • Do not stop using trazodone suddenly, as this could trigger unpleasant withdrawal symptoms. Consult with your doctor on how to safely stop using this medicine.

After the adequate response has been achieved, your doctor may begin reducing your dosage gradually for several months. The maintenance dosage will be decided upon by the doctor after observing what the lowest effective dose is and still with periodic reassessment.

6 What type of drug is trazodone?

Trazodone is an atypical anti-depressant drug. Anti-depressant drugs correct the chemical imbalances in the brain that cause mood and behavior disorders. Trazodone is part of a newer class of atypical anti-depressants, which affect both norepinephine and serotonin.

More popular atypical antidepressants are Prozac and Zoloft.

7 Trazodone safety

  • Trazodone should not be taken in larger or smaller amounts or for longer than prescribed by the doctor. Overdose can be very dangerous, and even fatal if paired with alcohol, barbiturates or sedatives. Symptoms are extreme drowsiness; vomiting; breathing that slows or stops; painful or prolonged penis or clitoral erection; and seizures like black-outs or convulsions. If you suspect that an overdose may have occurred, contact your physician or visit the emergency room immediately.
  • Some people may be allergic to the medication, watch out for the following symptoms: hives; difficulty breathing; swelling of the face, lips, tongue or throat.
  • Trazodone can also cause harm if you have any of the following conditions:
  • Taking an antidepressant during pregnancy may cause complications in the baby’s growth, like serious lung problems. Tell your doctor right away if you become pregnant while taking trazodone. Discontinuing medication could also cause you to have a relapse of depression, which is just as harmful for the baby. Do not stop, or start, taking this medicine during pregnancy without your doctor's advice. Similarly, advise your doctor if you are breastfeeding. The medication can be secreted in breast milk and endanger your baby.
  • Do not stop using trazodone suddenly. This could cause unpleasant withdrawal symptoms and relapse of depression. Consult your doctor on how to safely stop using this medicine.
  • Store at room temperature away from moisture, heat, and light.
  • Avoid alcohol, or at least drink limited portions. Alcohol is a central nervous system depressant. If taken along with trazodone, the drug can enhance the effects of alcohol. This may be detrimental to your health.
  • Avoid getting up too fast from a lying or sitting position. This may cause dizziness. Make sure to get up slowly and steady yourself first as a precaution to prevent a fall.
  • The medication may affect your thinking and impair your reactions. Take extra caution regarding daytime use. Driving and operating heavy machinery is inadvisable, especially during the first few weeks of treatment. Be mindful if you are doing anything that requires you to be alert.
  • Do not give or share this medicine with anyone below 18 years of age. Trazodone has not been approved by the Food and Drug Administration (FDA) as treatment for children. Also, make sure that this medicine is out of reach of children.

Trazodone

8 Trazodone drug interactions

Drug interactions may change the effect of your medications, depending on what you are taking and in what dosage. While this list is incomplete, it is a good place to start. Keep a list of all of your medications to share with your doctor and pharmacist. Your list should include prescription, non-prescription, and even herbal medicine.

  • Do not use trazodone if you are being treated with methylene blue injection.
  • You should not use trazodone, if in the last 14 days, you have also taken an MAO inhibitor, like: selegiline, isocarboxazid, phenelzine, linezolid, rasagiline, and tranylcypromine. After you stop with trazodone treatment, you should wait at least 14 days before taking an MAOI as well. Combining the use of trazodone and an MAOI may lead to high blood pressure, confusion, and tremors.
  • Check with your doctor before taking a non-steroidal anti-inflammatory drug (NSAID) for pain, arthritis, fever, or swelling. This includes your basic over the counter drugs like aspirin, ibuprofen (Motrin, Advil), celecoxib (Celebrex), naproxen (Aleve), diclofenac, indomethacin, meloxicam and others. These types of drugs may cause bleeding so the combined usage may cause you to bruise easily or even increase the chance of upper gastrointestinal bleeding.
  • Since trazodone causes drowsiness, be wary of other drugs you may be taking that also cause the same symptom. Watch out for antihistamines, sleep aids, muscle relaxants, and pain relievers. Check even your allergy and cough-and-cold medicine, as some ingredients may cause drowsiness.
  • Diuretics, when taken while having low levels of potassium and magnesium, may increase your risk of QT prolongation.
  • Taking trazodone can cause decreased metabolism for drugs like digoxin (Lanoxin) and phenytoin (Dilantin). Carbamazepine (Tegretol) may speed up the elimination of trazodone from the body. Ritonavir (Norvir), ketoconazole (Nizoral), and indinavir (Crixivan) inhibit the breakdown of trazodone. Inform your doctor if you are taking any of these medications. Your dosages may have to be adjusted to avoid overdosing.

Even if your doctor has already approved of you taking certain drugs together or at the same time, still be careful of the dosage. Do not change the dose of the drugs you are taking without informing your doctor first. The amount of the drugs that you take may change the way they react with each other.

9 Can trazodone be used for sleep?

Sleep disorders like insomnia are often linked with depression. So it comes as no surprise that anti-depressant medications would be useful for treating sleep disorders as well. Trazodone has been commonly prescribed, at lower doses, to treat insomnia because of its useful side effect, drowsiness. Many doctors argue that trazodone is an appropriate treatment for insomnia because it is less likely to cause dependency or, when stopped, renew insomnia. It is also believed to enhance slow-wave sleep, the third and fourth stage where deep and restorative sleep occurs and where brain and muscle activity is significantly decreased.

It has also shown to be effective in treating sleep disturbances, particularly in people with Alzheimer’s disease. It helped improve nighttime sleep, without causing grogginess or sleepiness and affecting brain function during the day.

However, the American Academy of Sleep Medicine recommends prescribing trazodone only when other drugs like Ambien and Lunesta have failed. We must remember that trazodone has been approved by the FDA to treat depression and not sleep disorders. Anti-depressants are powerful drugs, and hence they should only be used under the supervision and advice of a physician who is familiar with your symptoms and history.

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