Trazodone: Drug Information
1. Drug Name
Generic Name
Trazodone
Brand Name(s)
- Pakistan: BrandX
- India: BrandY
- US: Desyrel, Oleptro
- UK: Trazodone
2. Pharmacological Class
Class
Antidepressant
Subclass
Serotonin modulator
3. Mechanism of Action
Trazodone primarily inhibits serotonin reuptake and acts as an antagonist at serotonin 5-HT2A receptors, leading to increased serotonergic neurotransmission in the central nervous system. It also has alpha-1 adrenergic blocking properties.
4. Indications
Primary Indications
- Treatment of major depressive disorder (MDD)
- Insomnia associated with depression (off-label use)
Off-label Uses
- Adjunctive treatment for anxiety disorders
- Insomnia not associated with depression
5. Dosage and Administration
Standard Dosage
The dosage of trazodone should be individualized based on patient characteristics and response to therapy.
Route of Administration
Oral administration, usually as tablets or extended-release tablets.
Special Populations
- Pediatric: Safety and efficacy have not been established.
- Geriatric: Start with lower doses due to potential sensitivity.
6. Pharmacokinetics
Absorption
Trazodone is rapidly absorbed from the gastrointestinal tract.
Distribution
It is widely distributed throughout the body, including the brain.
Metabolism
Metabolized extensively in the liver via CYP3A4 and to a lesser extent by CYP2D6.
Excretion
The major route of elimination is renal excretion of metabolites.
Half-life
The elimination half-life is approximately 5 to 9 hours.
7. Contraindications
- Hypersensitivity to trazodone or any component of the formulation
- Use with MAO inhibitors or within 14 days of stopping MAO inhibitor therapy
8. Warnings and Precautions
- Suicidal thoughts and behaviors: Monitor for worsening depression or unusual changes in behavior.
- QT prolongation: Trazodone may prolong the QT interval; use with caution in patients at risk.
- Serotonin syndrome: Risk of serotonin syndrome when used with other serotonergic agents.
9. Side Effects
Common Side Effects
- Sedation
- Dizziness
- Dry mouth
Serious Side Effects
- Priapism (prolonged erection)
- Severe hypotension
- Seizures
10. Drug Interactions
Major Interactions
- MAO inhibitors
- Other antidepressants (e.g., SSRIs, SNRIs)
Moderate Interactions
- Antipsychotics
- Benzodiazepines
Minor Interactions
- Alcohol
- Cimetidine
11. Pregnancy and Lactation
Pregnancy Category
Category C - Risk cannot be ruled out.
Breastfeeding Considerations
Use caution; trazodone is excreted into human milk.
12. Patient Counseling Information
- Take trazodone as prescribed; do not exceed the recommended dose.
- Avoid alcohol and other sedative drugs while taking trazodone.
- Discuss with healthcare provider before starting trazodone, especially if pregnant, breastfeeding, or taking other medications.