Last reviewed:
Nov 23rd 2022
PharmD, BCPS
Trazodone is a prescription antidepressant medication for adults and works as a serotonin antagonist and reuptake inhibitor (SARIs). This medication is used to treat depressive disorder and anxiety. Tell your doctor if you have suicidal or self-harming thoughts, as they may increase when starting treatment, which usually takes at least two weeks to work.
Trazodone is sold under the following brand names:
Trazodone is prescribed to treat:
This drug is used to improve energy level, appetite and mood and to decrease insomnia and anxiety related to that psychiatric disorder.
Your healthcare provider may prescribe trazodone to treat insomnia and schizophrenia, control movements caused by the side effects of other medications, and to treat alcoholism. [1]
You should never take trazodone without proper medical advice or supervision.
Trazodone belongs to a group of medicaments called serotonin receptor antagonists and reuptake inhibitors (SARIs). It works by increasing the amount of serotonin, a natural substance in the brain that helps maintain mental balance, which is necessary for nerve cells and the brain to function properly.
Trazodone is a triazolopyridine derivative that inhibits the reuptake of serotonin by the neuronal presynaptic membrane. Unlike other antidepressants, this drug has no effect on the reuptake of norepinephrine or dopamine in the central nervous system. Therefore, it does not enhance the cognitive and affective functions modulated by these neurotransmitters, norepinephrine and dopamine, such as increased alertness, anticipation, perseverance or motivation. This results in sedative and hypnotic effects typical of this drug and is believed to be produced by an alpha-adrenergic blockade and a histamine blockade. [2]
You should follow your doctor or pharmacists instructions for administering this medicine. If you have any doubts, you should consult your doctor or pharmacist again. [3]
For the treatment of depression and/or generalized anxiety disorder:
In adults, the recommended starting dose of trazodone is 50-100 mg/day. The dose can be increased by 50 mg/day every 3-4 days, up to 300 mg/day, as needed. In the case of taking the divided dose before each meal, the larger portion should be taken before bedtime.
Trazodone is an antidepressant, but it does not cure depression or anxiety. Instead, it only minimizes its symptoms. Its beneficial effect will begin to be felt two weeks after starting treatment. Trazodone should be continued for the time indicated by the doctor, even if the patient feels well.
For the treatment of insomnia in adults, the recommended dose is 50mg before bedtime.
For treating alcohol use disorder in adults, a dose of 50-100mg once a day is recommended.
Each oral tablet usually contains 100 mg of trazodone hydrochloride and can be divided into equal doses of 50mg. In this way, the physician can increase or decrease the dose gradually.
Trazodone is mainly eliminated through urine, excreting about 75% of the dose within 72 hours. About 20% is excreted via the biliary route in the feces. [4]
Trazodone has a two-phase elimination. The first phase has a half-life of about 1 hour and about 8 hours for the second phase. Thus, the drug has a terminal elimination half-life of 5 to 13 hours.
The drug is distributed mainly in the liver and, to a lesser extent, in the kidneys, small intestine, lungs, adrenal glands and pancreas, and can cross the blood-brain barrier. Trazodone can also be excreted in breast milk.
Trazodone may cause side effects, although not all people experience them. Inform your doctor if these symptoms are severe or persistent: [5]
If you experience any of the following effects, you should stop taking trazodone and see your doctor immediately:
If you notice the following serious side effects, seek medical attention immediately:
This list does not mention all side effects. If you experience any type of side effect, consult your doctor. [6]
Before taking trazodone:
Trazodone can be excreted through breast milk, so you should tell your doctor if you are pregnant, plan to become pregnant or are breast-feeding. [7]
It is also important to tell your doctor if you have surgery, including dental surgery.
Trazodone may cause dizziness, so you should avoid performing potentially dangerous tasks, such as driving or operating machinery, until you understand how this medicine affects you.
The use of alcohol or cannabis may increase the adverse effects of trazodone, especially those related to psychomotor disturbances.
Several drugs can interfere with the beneficial effects of trazodone. Some of them are listed below. Please inform your doctor if you are taking other medications: [8]
The medicine should be stored in a shaded (below 86 F), cool and dry place. It must be kept in its original container and out of sight and reach of children.
Ask your pharmacist for proper handing to dispose of leftover or expired medicines. Doing so will avoid risks to public health and the environment.
In case of an overdose, consult your doctor or pharmacist immediately or go to the nearest hospital.
The most common side effects of excessive ingestion are general malaise, dizziness, drowsiness, convulsions, confusion, arrhythmias, breathing difficulties or painful erections that do not subside.
The beneficial effects of trazodone usually appear two weeks after the first intake. However, it is important to remember that symptoms related to depression and/or anxiety may increase slightly during the first days of its use.
Antidepressants do not produce dependence, but it is advisable to reduce the dose gradually when treatment ends to avoid a rebound effect, mainly related to insomnia.
Both prescription drugs belong to the group of sedative antidepressants.
One of the main differences between the two drugs is the dosage used. The dose of mirtazapine is usually quite a bit lower, at 15 to 45 mg per day, while the dose used with trazodone is usually 50 to 400 mg per day. In addition, while both drugs are used to treat depression, anxiety and insomnia, mirtazapine is also prescribed to treat generalized anxiety and post-traumatic stress disorder.
Regarding its mechanism of action, mirtazapine has a dual antidepressant effect, as it potentiates the neurotransmitters serotonin and noradrenaline. In contrast, trazodone only acts at the serotonin level. Another effect of this difference in the mechanism of action is that while mirtazapine induces an increase in appetite and weight gain, trazodone does not.
Both antidepressant drugs produce drowsiness, so it is convenient to take them at night. In the case of mirtazapine, this effect does not increase when the dose is increased, but in trazodone, it does. Therefore, when treating insomnia with trazodone, it is important to increase the dose gradually according to the patient’s response.
Although neither drug produces severe sexual dysfunction, as with other antidepressants, trazodone has the lesser effect of the two concerning this adverse reaction.
Another important difference between trazodone and mirtazapine is the half-life of their antidepressant effect. Trazodone has a shorter half-life of 5 to 9 hours, while the half-life of mirtazapine in the body is 20 to 40 hours. This is why mirtazapine is usually taken in single doses and trazodone in at least three doses per day. Therefore, in treating insomnia, the use of trazodone is more effective since it can be limited to hours of sleep. [9]
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