II. Indications

  1. Major Depression (largely replaced by SSRI and SNRI agents)
  2. Aggressive Behavior (off label)
  3. Cocaine Withdrawal (off label)
  4. Erectile Dysfunction
    1. See Erectile Dysfunction Management for more effective agents
  5. Insomnia
    1. Not recommended due to low efficacy and adverse effects including Fall Risk
    2. Sateia (2017) J Clin Sleep Med 13(2): 307-49 [PubMed]

III. Mechanism

  1. Triazolopyridine derivative
  2. Unrelated to Tricyclic Antidepressants
  3. Phenylpiperazine Antidepressant (Serzone prototype)
  4. Serotonin Antagonist and Reuptake Inhibitor (SARI)
    1. Blocks 5-HT-2 postsynaptic receptor
    2. Low dose: Serotonin receptor Antagonist
    3. High dose: Serotonin Agonist
    4. Weaker than SSRIs as a Serotonin reuptake inhibitor

IV. Pharmacokinetics

  1. Serum Half Life: 4 to 9 hours
  2. Therapeutic plasma level: 800 to 1600
  3. Well absorbed
  4. Extensive hepatic metabolism

V. Safety

  1. Pregnancy Category C
  2. Avoid in Lactation

VI. Efficacy

  1. Major Depression
    1. As effective as Fluoxetine, Tricyclic Antidepressants
  2. Insomnia
    1. Decreases nightly awakenings
    2. Slight improvement on sleep quality
    3. Does NOT increase sleep time, Sleep Efficiency, Sleep Latency or waking time after sleep onset
    4. References
      1. Yi (2018) Sleep Med 45:25-32 [PubMed]
      2. Everitt (2018) Cochrane Database Syst Rev (5): CD010753 [PubMed]

VII. Background

VIII. Dosing

  1. Insomnia
    1. Dose: 50 mg orally at bedtime
    2. Range: 25-100 mg orally at bedtime
    3. Maximum: 150 mg orally at bedtime
  2. Major Depression
    1. Start: 50 to 150 mg per day in divided doses
    2. Effective dose: 400 to 600 mg in divided doses

IX. Adverse Effects

  1. Sedation
    1. Limits use as an Antidepressant
    2. Useful in Major Depression with Insomnia
  2. Priapism
    1. See Priapism Management
  3. Serotonin Syndrome
  4. Cardiac Arrhythmia
  5. Decreased Appetite
  6. Orthostatic Hypotension (Dizziness)
    1. Minimize by administering with food
  7. Fall Risk
    1. Increased risk of falls when used for Insomnia
    2. Fall Risk is higher with Trazodone than with Zolpidem or Benzodiazepines
    3. Amari (2022) Adv Ther 39(3): 1324-40 [PubMed]

X. Drug Interaction

  1. Metabolized by CYP3A4 and CYP2D6
  2. Increased serum Digoxin level
  3. Increased Phenytoin level

XI. Toxicity

XIII. References

  1. (2023) Med Lett Drugs Ther 62(1592): 25-32
  2. Olson (2020) Clinical Pharmacology, Medmaster Miami, p. 38-9
  3. Hamilton (2020) Tarascon Pocket Pharmacopoeia
  4. Sundberg (1995) Depression Primary Care, PGM, p. 45-57

Images: Related links to external sites (from Bing)

Related Studies

Cost: Medications

trazodone (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
TRAZODONE 100 MG TABLET Generic $0.07 each
TRAZODONE 150 MG TABLET Generic $0.12 each
TRAZODONE 300 MG TABLET Generic $1.40 each
TRAZODONE 50 MG TABLET Generic $0.04 each

Ontology: Trazodone (C0040805)

Definition (CHV) a kind of depression treatment drug
Definition (CHV) a kind of depression treatment drug
Definition (NCI) A synthetic triazolopyridine derivative, antidepressant and sedative Trazodone acts as a serotonin uptake inhibitor, chemically unrelated to tricyclic, tetracyclic, or other antidepressants. It is effective in patients with schizoaffective disorders; major depressive disorders; and depressive disorders associated with insomnia and anxiety. (NCI04)
Definition (MSH) A serotonin uptake inhibitor that is used as an antidepressive agent. It has been shown to be effective in patients with major depressive disorders and other subsets of depressive disorders. It is generally more useful in depressive disorders associated with insomnia and anxiety. This drug does not aggravate psychotic symptoms in patients with schizophrenia or schizoaffective disorders. (From AMA Drug Evaluations Annual, 1994, p309)
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D014196
SnomedCT 372829000, 7336002
LNC LP16297-1, MTHU005053
English Tradozone, Trazodone, 1,2,4-Triazolo(4,3-a)pyridin-3(2H)-one, 2-(3-(4-(3-chlorophenyl)-1-piperazinyl)propyl)-, Searle Brand of Trazodone Hydrochloride, Trazodone [Chemical/Ingredient], tradozone, traZODone, TRAZODONE, trazodone, Trazodone (product), Trazodone (substance)
Swedish Trazodon
Czech trazodon
Finnish Tratsodoni
Russian TRAZODON, ТРАЗОДОН
Japanese トラゾドン
Polish Trazodon
Spanish trazodona (producto), trazodona (sustancia), trazodona, Trazodona
French Trazodone
German Trazodon
Italian Trazodone
Portuguese Trazodona

Ontology: Desyrel (C0701914)

Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D014196
English desyrel, Desyrel, Apothecon Brand of Trazodone Hydrochloride, Bristol Myers Squibb Brand of Trazodone Hydrochloride, Bristol-Myers Squibb Brand of Trazodone Hydrochloride