From the Guidelines
Trazodone can be used as an adjunctive medication to mitigate anxiety, insomnia, and irritability in patients undergoing opioid withdrawal, as supported by the consensus panel recommendations published in the Mayo Clinic Proceedings in 2020 1. When considering the use of trazodone in this context, it is essential to note that while it is not specifically approved for opioid withdrawal, it has been found to be beneficial in managing symptoms such as insomnia. The typical dosage of trazodone for this purpose is 50-100mg taken orally at bedtime, with a maximum dose of 200mg if needed for sleep. Key points to consider when using trazodone for opioid withdrawal include:
- Trazodone works as a serotonin antagonist and reuptake inhibitor, helping to regulate sleep architecture without the dependence risks associated with benzodiazepines or z-drugs.
- It should be part of a comprehensive withdrawal management plan that includes primary medications like buprenorphine, methadone, or alpha-2 agonists (clonidine or lofexidine).
- Side effects to monitor include orthostatic hypotension, morning drowsiness, and rarely priapism in males.
- Trazodone can typically be continued for several weeks during the acute and post-acute withdrawal phases and then tapered as sleep normalizes. It is crucial to weigh the benefits of trazodone against potential risks and to carefully monitor patients for any adverse effects, especially given the lack of strong, recent evidence specifically supporting its use in opioid withdrawal management beyond the general consensus and older literature 1.
From the Research
Trazodone in Opioid Withdrawal
- There is limited evidence to suggest the use of trazodone in opioid withdrawal, as the provided studies primarily focus on its off-label uses for conditions such as insomnia, anxiety disorders, and chronic pain 2, 3, 4.
- Trazodone's pharmacology, including its serotonergic and adrenolytic properties, may warrant further exploration for its potential utility in various disorders, including opioid withdrawal 4.
- However, the current standards of care for medically supervised withdrawal from opioids include treatment with μ-opioid receptor agonists, partial agonists, and α2-adrenergic receptor agonists, with no mention of trazodone as a treatment option 5.
- Studies on opioid withdrawal have focused on managing withdrawal symptoms during transition to antagonist treatment, such as extended-release naltrexone, and have not investigated the use of trazodone in this context 5, 6.
- Overall, there is a lack of research on the use of trazodone in opioid withdrawal, and its potential efficacy and safety in this context are unknown.