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Trazodone hydrochloride
Trazodone hydrochloride (Desyrel)
Trazodone hydrochloride
(TRAYZ-oh-dohn)
Pregnancy Category: C Alti-Trazodone Alti-Trazodone Dividose Apo-Trazodone Apo-Trazodone D Desyrel Desyrel Dividose Dom-Trazodone Gen-Trazodone Novo-Trazodone Nu-Trazodone Nu-Trazodone-D PMS-Trazodone Trazorel (Rx)

Classification: Antidepressant, miscellaneous

Action/Kinetics: A novel antidepressant that does not inhibit MAO and is also devoid of amphetamine-like effects. Response usually occurs after 2 weeks (75% of clients), with the remainder responding after 2-4 weeks. May inhibit serotonin uptake by brain cells, therefore increasing serotonin concentrations in the synapse. May also cause changes in binding of serotonin to receptors. Causes moderate sedative and orthostatic hypotensive effects and slight anticholinergic effects. Peak plasma levels: 1 hr (empty stomach) or 2 hr (when taken with food). t1/2, initial: 3-6 hr; final: 5-9 hr. Effective plasma levels: 800-1,600 ng/mL. Time to reach steady state: 3-7 days. Three-fourths of those with a therapeutic effect respond by the end of the second week of therapy. Metabolized in liver and excreted through both the urine and feces.

Uses: Depression with or without accompanying anxiety. Investigational: In combination with tryptophan for treating aggressive behavior. Panic disorder or agoraphobia with panic attacks. Treatment of cocaine withdrawal. In combination with a selective serotonin reuptake inhibitor to treat insomnia.

Contraindications: During the initial recovery period following MI. Concurrently with electroshock therapy.

Special Concerns: Use with caution during lactation. Safety and efficacy in children less than 18 years of age have not been established. Geriatric clients are more prone to the sedative and hypotensive effects.

Side Effects: General: Dermatitis, edema, blurred vision, constipation, dry mouth, nasal congestion, skeletal muscle aches and pains. CV: Hypertension or hypotension, syncope, palpitations, tachycardia, SOB, chest pain. GI: Diarrhea, N&V;, bad taste in mouth, flatulence. GU: Delayed urine flow, priapism, hematuria, increased urinary frequency. CNS: Nightmares, confusion, anger, excitement, decreased ability to concentrate, dizziness, disorientation, drowsiness, lightheadedness, fatigue, insomnia, nervousness, impaired memory. Rarely, hallucinations, impaired speech, hypomania. Other: Incoordination, tremors, paresthesias, decreased libido, appetite disturbances, red eyes, sweating or clamminess, tinnitus, weight gain or loss, anemia, hypersalivation. Rarely, akathisia, muscle twitching, increased libido, impotence, retrograde ejaculation, early menses, missed periods.

Overdose Management: Symptoms: CNS depresssion, including respiratory arrest, seizures ECG changes, hypotension, priapism as well as an increase in the incidence and severity of side effects noted above (vomiting and drowsiness are the most common). Treatment: Treat symptoms (especially hypotension and sedation). Gastric lavage and forced diuresis to remove the drug from the body.

Drug Interactions: Alcohol / Depressant effects Antihypertensives / Additive hypotension Barbiturates / Depressant effects Carbamazepine / Plasma levels of trazodone and its active metabolite Clonidine / Clonidine effects CNS depressants / CNS depression Digoxin / Serum digoxin levels MAO inhibitors / Initiate therapy cautiously if used together Phenothiazines / Trazodone serum levels Phenytoin / Serum phenytoin levels Selective serotonin reuptake inhibitors / "Serotonin syndrome," including irritability, shivering, myoclonus, increased muscle tone, and altered consciousness Warfarin / Either or PT

How Supplied: Tablet: 50 mg, 100 mg, 150 mg, 300 mg

Dosage
•Tablets Antidepressant.
Adults and adolescents, initial: 150 mg/day; then, increase by 50 mg/day every 3-4 days to maximum of 400 mg/day in divided doses (outpatients). Inpatients may require up to, but not exceeding, 600 mg/day in divided doses. Maintenance: Use lowest effective dose. Geriatric clients: 75 mg/day in divided doses; dose can then be increased, as needed and tolerated, at 3- to 4-day intervals.
Treat aggressive behavior.
Trazodone, 50 mg b.i.d., with tryptophan, 500 mg b.i.d. Dosage adjustments may be required to reach a therapeutic response or if side effects develop.
Panic disorder or agoraphobia with panic attacks.
300 mg/day.
Insomnia.
25-75 mg, often with a selective serotonin reuptake inhibitor.