Trazodone

Serotonin antagonist and reuptake inhibitor (SARI), Antidepressant, Sleep aid

Trazodone

Desyrel (original IR), Oleptro (ER), Trittico

Experience

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Problems

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Titration strategies

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Effects

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Patient counseling

Priapism is a recognized, uncommon adverse effect of trazodone, attributed to alpha-1 adrenergic antagonism in penile vasculature; cases requiring surgical intervention or resulting in permanent erectile dysfunction have been reported. Patients should be counseled that a prolonged erection, generally one lasting more than 4 hours, or any painful erection unrelated to sexual activity, is a medical emergency requiring immediate care, because delayed treatment risks permanent damage.

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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

Common uses

Classification(s)

Classes

Serotonin antagonist and reuptake inhibitor (SARI), Antidepressant, Sleep aid

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

Bioavailability

~65% (oral)

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

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.

Pharmacopedia is intended for reference. Nothing here is advice. In an emergency call 911; US Poison Control 1-800-222-1222. See the full disclaimer.