Trazodone

Aka: Trazodone, Desyrel, Oleptro

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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

  1. Generic Drug

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

  1. Less toxic in Overdose than Tricyclic Antidepressants
  2. Lower Incidence of Anticholinergic Toxicity

XII. Resources

  1. Trazodone (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=17b3356e-458d-47f6-89a5-80828ab48d4c

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

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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
FPNotebook does not benefit financially from showing this medication data or their pharmacy links. This information is provided only to help medical providers and their patients see relative costs. Insurance plans negotiate lower medication prices with suppliers. Prices shown here are out of pocket, non-negotiated rates. See Needy Meds for financial assistance information. GoodRx is another tool for finding lower drug prices.

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