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NERVOUS SYSTEM › PSYCHOANALEPTICS › ANTIDEPRESSANTS › Other antidepressants
trazodone
N06AX05
Forms & Strengths
- Oral tablets: 50 mg, 100 mg, 150 mg, 300 mg
- Extended-release tablets (Oleptro): 150 mg, 300 mg
Adult Dosing
- Major Depressive Disorder (Immediate-release): Initial 150 mg/day divided in doses, increased by 50 mg/day every 3 to 4 days; max 400 mg/day (outpatient) or 600 mg/day (inpatient).
- Major Depressive Disorder (Extended-release): Initial 150 mg once daily at bedtime, increased by 75 mg/week; max 375 mg/day.
- Insomnia (Off-label): 25 mg to 100 mg orally once daily at bedtime.
Pediatric Dosing
- Major Depressive Disorder (Children/Adolescents): Safety and efficacy not established in pediatric patients under 18 years.
- Insomnia (Off-label, adolescents): 25 mg to 50 mg at bedtime, titrated cautiously if necessary under specialist supervision.
Indications
- Major depressive disorder
- Insomnia (off-label use)
Mechanism of Action
- Serotonin antagonist and reuptake inhibitor (SARI).
- Inhibits serotonin reuptake, blocks alpha-1 adrenergic receptors, and blocks histamine H1 receptors.
- Potent antagonist at 5-HT2A and 5-HT2C receptors.
Contraindications
- Hypersensitivity to trazodone
- Concurrent administration of monoamine oxidase inhibitors (MAOIs) or use within 14 days of stopping MAOIs
- Co-administration with linezolid or intravenous methylene blue
Adverse Reactions
- Somnolence and sedation
- Dizziness and orthostatic hypotension
- Dry mouth and blurred vision
- Priapism (rare, medical emergency)
- QT prolongation and cardiac arrhythmias
- Serotonin syndrome (when combined with other serotonergic agents)
Drug Interactions
- Monoamine oxidase inhibitors (MAOIs): Risk of serotonin syndrome and hypertensive crisis.
- CYP3A4 inhibitors (e.g., ketoconazole, ritonavir): Increase trazodone plasma concentrations and toxicity risk.
- CYP3A4 inducers (e.g., carbamazepine): Decrease trazodone plasma concentrations.
- CNS depressants (e.g., alcohol, benzodiazepines, opioids): Enhanced sedation and respiratory depression.
- Antihypertensive agents: Increased risk of severe hypotension.
- Serotonergic agents (SSRIs, SNRIs, triptans): Increased risk of serotonin syndrome.
Curated Content: Needs Vetting Before Put to Clinical Use