Have there been reported fatalities associated with concurrent use of trazodone (an antidepressant) and melatonin (a sleep aid)?

From the Guidelines

There is no documented evidence of fatal cases specifically attributed to the combination of trazodone and melatonin, but caution is advised due to potential increased sedation and serotonin syndrome risk. When considering the use of trazodone and melatonin together, it's essential to understand their mechanisms of action and potential interactions. Trazodone is an antidepressant that affects serotonin receptors, while melatonin is a hormone that regulates sleep cycles 1. The combination of these medications may cause increased drowsiness, dizziness, and impaired coordination.

Key Considerations

• Trazodone and melatonin can cause sedation, and their combined use may exacerbate this effect
• Serotonin syndrome is a potential risk when combining serotonergic medications, although melatonin is not typically considered a strong serotonergic agent
• Close monitoring is recommended when combining these medications, especially in patients with underlying health conditions or those taking other medications
• Patients should consult with their healthcare provider before taking trazodone and melatonin together, and start with the lowest effective doses if approved

Potential Risks and Consequences

• Increased sedation and impaired coordination may increase the risk of accidents or injuries
• Serotonin syndrome, although rare, can be life-threatening and requires immediate medical attention
• Other potential interactions or side effects may occur, emphasizing the need for careful monitoring and professional guidance

Recommendations

• Consult with a healthcare provider before taking trazodone and melatonin together
• Start with the lowest effective doses if the combination is approved
• Monitor for increased sedation, dizziness, and impaired coordination
• Seek immediate medical attention if excessive sedation, confusion, or difficulty breathing occurs after taking these medications together 1.

From the Research

Trazodone and Melatonin Interaction

• There is no direct evidence in the provided studies that suggests taking trazodone and melatonin at the same time has resulted in fatalities 2, 3, 4, 5, 6.
• The studies primarily focus on the efficacy and safety of trazodone and melatonin as separate treatments for sleep disorders and insomnia, rather than their combined use 2, 3, 4, 5, 6.
• One study compared the use of melatonin, trazodone, and doxepin in psychiatric patients with sleep disturbances, but it did not investigate the concurrent use of trazodone and melatonin 2.
• Another study compared melatonin and trazodone for the treatment of new-onset insomnia in hospitalized adult patients, but it did not report on the combined use of these medications 3.
• A randomized, double-blind trial compared the safety and efficacy of melatonin, clonazepam, and trazodone in patients with Parkinson's disease and sleep disorders, but it did not examine the combined use of trazodone and melatonin 4.

Safety and Efficacy of Trazodone and Melatonin

• Trazodone has been shown to be effective in improving sleep quality and reducing daytime drowsiness, but it can have adverse effects such as morning grogginess and orthostatic hypotension 2, 6.
• Melatonin has been found to be effective in improving sleep quality and reducing daytime drowsiness, with fewer adverse effects compared to trazodone 2, 3, 4.
• The safety and efficacy of combining trazodone and melatonin have not been directly studied in the provided evidence 2, 3, 4, 5, 6.