Trazodone: Difference between revisions

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{{MedTemplate

| generic = Trazodone

| brand = Desyrel

| brand = Desyrel (original IR), Oleptro (ER), Trittico

| structure =

| classes = SARI, Antidepressant, ~~Sedative-Hypnotic~~

| classes = [[:Category:SARIs|Serotonin antagonist and reuptake inhibitor (SARI)]], [[:Category:Antidepressants|Antidepressant]], [[:Category:Sleep aids|Sleep aid]]

| ~~mechanism~~ = ~~Serotonin reuptake inhibitor and 5~~-~~HT2A antagonist~~

| uses = <vote slug="major-depressive-disorder-use">Major depressive disorder (FDA, original indication)</vote>, <vote slug="insomnia-trazodone-use">Insomnia (off-label; vastly more common in current practice than the depression indication)</vote>, <vote slug="anxiety-adjunct-use">Anxiety disorder adjunct (off-label)</vote>, <vote slug="ptsd-sleep-disturbance-use">PTSD-related sleep disturbance (off-label)</vote>

~~| uses~~ =

| starting_dose = Insomnia (off-label): 25-50 mg PO at bedtime, titrate to effect. Depression: 150 mg/day divided BID-TID; titrate to 400 mg/day outpatient or 600 mg/day inpatient

| starting_dose =

| preparations = IR tablets 50, 100, 150, 300 mg; Oleptro ER tablets 150, 300 mg

| preparations =

| fda_max = 400 mg/day outpatient; 600 mg/day inpatient

| ~~routes =~~

| pill_id =

~~| onset~~ =

| routes = Oral

| ~~duration~~ =

| onset = Sleep effect within 30-60 minutes; antidepressant effect over 1-2 weeks

| ~~halflife~~ =

| duration = ~6-8 hours (IR); 24 hours (Oleptro ER)

| ~~bioavailability~~ =

| halflife = Biphasic: ~3-6 hours alpha, ~5-9 hours beta<ref name="trazodone-label">FDA Prescribing Information, Desyrel (trazodone hydrochloride), Apotex/various, current revision. https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/018207s032lbl.pdf</ref>

| ~~pregnancy~~ =

| bioavailability = ~65% (oral)<ref name="trazodone-label" />

| ~~legal~~ =

| pregnancy = Limited human data; observational signals inconclusive.{{citation needed}}

~~| intro~~ =

| legal = [[USLegal:Prescription only|Rx-only]] in US. Carries the antidepressant '''Boxed Warning''' for suicidality in children, adolescents, and young adults<ref name="trazodone-label" />

| ~~pharmacokinetics~~ =

| mechanism = <vote slug="trazodone-mech-claim">Combined strong 5-HT2A antagonism with weaker serotonin reuptake inhibition (the SARI class signature). At the low doses used for insomnia (25-100 mg), 5-HT2A antagonism, H1 antihistaminergic effect, and α1-adrenergic antagonism dominate, producing sedation; at antidepressant doses (≥150 mg) the SRI contribution adds. The active metabolite mCPP is a 5-HT2C agonist that may contribute to anxiogenesis in some patients.</vote> '''Priapism''' is a recognized rare adverse effect via α1 antagonism in penile vasculature and is the marquee counseling point for male patients<ref name="trazodone-label" />.

~~| pharmacodynamics~~ =

| ~~indications~~ =

| ~~dosing~~ =

| ~~effects~~ =

| ~~contraindications~~ =

~~| interactions~~ =

~~| pregnancy_details =~~

~~| monitoring =~~

| counseling =

~~| anecdotes =~~

~~| seealso =~~

~~| references~~ =

}}

== References ==

[[Category:SARIs]]

[[Category:Antidepressants]]

[[Category:Sleep aids]]

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