trazodone DESYREL
Class: SARI/TriazolopyridineFDA Indications: MDD
Off-Label Use: Insomnia, SSRI-induced Sexual Dysfunction, Bulimia Nervosa, Fibromyalgia, Anxiety, Agitation And Aggression In Dementia, Neuroleptic-induced Acute Akathisia, Sleep Disturbances In Alzheimer's Disease
Prescribing
Forms: 50, 100, 150, 300mg tabletDose Range: 150-600 mg/day
Starting: Start 150 mg qd in divided doses for depression, ↑ 50mg q3-4 days, max 600 mg qd; for insomnia 25-150 mg qhs
Stopping: Gradually taper dose
Precautions
Contraindications: Concomitant use of MAOIs, not recommended for use s/p MISerious Side Effects: priapism (1:8,000-10,000); may be arrhythmogenic in patients with pre-existing CV disease; can prolong QTC
Conditional Risk of TdP
Side Effects: dizziness, sedation/somnolence, lightheadedness, xerostomia, visual changes, tremor, ataxia, myalgia, headache, constipation, orthostatic hypotension, hyperhidrosis
Pharmacodynamics
1° MOA: Serotonin antagonist/reuptake inhibitorTarget: Antagonism at:
Pharmacokinetics
t½: 7 (5-9)° TMAX: 2°Substrate of: 3A4; 2D6
Inhibits: ∅ ; Induces: ∅
Active Metabolites: mCPP
DDIs
- - DO NOT CO-PRESCRIBE WITH MAOIs
- - 3A4 inhibitors can ↑ levels; likewise, 3A4 inducers can ↓ levels
Misc
- - biphasic t½: 1st phase is 3-6°, 2nd is 5-9°
- - minimal anticholinergic effects
- - attractive option for patients with h/o drug/etoh abuse
- - despite being second most commonly rx'd 'sleeper' (after Ambien), evidence for efficacy is very limited
Special Populations
Category C—The animal and limited human data suggest that the risk for major malformations in the embryo is low. Studies for other aspects of developmental toxicity in the embryo-fetus, however, have not been conducted.
Although the amount of trazodone in milk is very small (RID 2.8%), in 2001 the American Academy of Pediatrics classified trazodone as a drug for which the effect on nursing infants is unknown but may be of concern.
May require lower doses. Start low.
No dosage adjustment necessary.
Use with caution. Dosage adjustment required based on severity of impairment.
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