Trazodone: Difference between revisions

Major depressive disorder (FDA, original indication)0, Insomnia (off-label; vastly more common in current practice than the depression indication)0, Anxiety disorder adjunct (off-label)0, PTSD-related sleep disturbance (off-label)0

Pharmacy

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

Preparations

IR tablets 50, 100, 150, 300 mg; Oleptro ER tablets 150, 300 mg

US FDA Max

400 mg/day outpatient; 600 mg/day inpatient

Pharmacology

Routes

Oral

Onset

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

Duration

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

Half-life

Biphasic: ~3-6 hours alpha, ~5-9 hours beta^[1]

Bioavailability

~65% (oral)^[1]

Pregnancy

Limited human data; observational signals inconclusive.^{[citation needed]}

Legal status

Rx-only in US. Carries the antidepressant Boxed Warning for suicidality in children, adolescents, and young adults^[1]

Purported mechanism

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.0 Priapism is a recognized rare adverse effect via α1 antagonism in penile vasculature and is the marquee counseling point for male patients^[1].

References

↑ ^1.0 ^1.1 ^1.2 ^1.3 FDA Prescribing Information, Desyrel (trazodone hydrochloride), Apotex/various, current revision. https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/018207s032lbl.pdf

[trazodone-label-1] 1.0 ^1.1 ^1.2 ^1.3 FDA Prescribing Information, Desyrel (trazodone hydrochloride), Apotex/various, current revision. https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/018207s032lbl.pdf

[1]

@@ Line 1: / Line 1: @@
 {{MedTemplate
-| generic            = Trazodone
+| generic           = Trazodone
-| brand              = Desyrel
+| brand             = Desyrel (original IR), Oleptro (ER), Trittico
-| structure          =
+| 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
-| fda_max           =
+| pill_id           =
-| routes             =
+| routes            = Oral
-| onset              =
+| onset             = Sleep effect within 30-60 minutes; antidepressant effect over 1-2 weeks
-| duration           =
+| duration          = ~6-8 hours (IR); 24 hours (Oleptro ER)
-| halflife           =
+| 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>
-| bioavailability    =
+| bioavailability   = ~65% (oral)<ref name="trazodone-label" />
-| pregnancy          =
+| pregnancy         = Limited human data; observational signals inconclusive.{{citation needed}}
-| legal              =
+| 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" />
-| intro              =
+| 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" />.
-| pharmacokinetics   =
-| pharmacodynamics   =
-| indications        =
-| dosing             =
-| effects            =
-| interactions       = <pharmaInteractions/>
-| pregnancy_details  =
-| monitoring         =
-| counseling         =
-| anecdotes          =
-| seealso            =
-| references         =
 }}
+== References ==
+<references />
+[[Category:SARIs]]
 [[Category:Antidepressants]]
-[[Category:Serotonin Antagonist and Reuptake Inhibitors (SARIs)]]
+[[Category:Sleep aids]]

MDElliottMD (talk | contribs)

Latest revision as of 06:26, 23 May 2026

Experience

Problems

Titration strategies

Effects

Relevant anecdote

Relevant Literature

References