From the FDA Drug Label
5.2 Serotonin Syndrome The development of a potentially life-threatening serotonin syndrome has been reported with SNRIs and SSRIs, including Escitalopram, alone but particularly with concomitant use of other serotonergic drugs (including triptans, tricyclic antidepressants, fentanyl, lithium, tramadol, tryptophan, buspirone, amphetamines, and St John’s Wort) and with drugs that impair metabolism of serotonin (in particular, MAOIs, both those intended to treat psychiatric disorders and also others, such as linezolid and intravenous methylene blue).
5.2 Serotonin Syndrome Serotonin-norepinephrine reuptake inhibitors (SNRIs) and SSRIs, including Trazodone Hydrochloride Tablets, can precipitate serotonin syndrome, a potentially life-threatening condition. The risk is increased with concomitant use of other serotonergic drugs (including triptans, tricyclic antidepressants, fentanyl, lithium, tramadol, tryptophan, buspirone, and St. John’s Wort) and with drugs that impair metabolism of serotonin, i. e., MAOIs [see CONTRAINDICATIONS (4), DRUG INTERACTIONS (7.1)].
Concurrent use of trazodone and escitalopram may increase the risk of serotonin syndrome.
- The FDA drug labels for both trazodone and escitalopram warn about the risk of serotonin syndrome when used alone or in combination with other serotonergic drugs.
- It is recommended to use caution and monitor patients closely if concurrent use is necessary 1 2.
- Alternative treatment options should be considered to minimize the risk of serotonin syndrome.
From the Research
Trazodone and escitalopram can be used concurrently, but with caution and under the guidance of a healthcare provider, due to the potential risk of serotonin syndrome, as reported in a study published in 2014 3. Trazodone is typically used for insomnia or as an antidepressant, while escitalopram is an SSRI antidepressant. When combined, they may help manage depression and sleep issues simultaneously. However, the specific dosages and timing of administration should be determined by a doctor based on individual needs and medical history. It's crucial to be aware that combining these medications can increase the risk of serotonin syndrome, a potentially serious condition caused by excessive serotonin levels. Patients should monitor for symptoms like agitation, confusion, rapid heart rate, or fever, and report any concerns to their doctor immediately. Some key points to consider when using trazodone and escitalopram together include:
- Monitoring for symptoms of serotonin syndrome, such as agitation, confusion, and rapid heart rate, as reported in a study published in 1995 4
- Being cautious when driving or operating machinery, especially when starting the combination or adjusting doses, due to the potential for drowsiness
- Always taking these medications exactly as prescribed and not adjusting dosages without consulting a healthcare provider
- Being aware of the potential risk factors for serotonin syndrome, such as increased age, higher dosages, and use of concomitant potent cytochrome P450 2D6 inhibitors, as reported in a study published in 2014 3 Additionally, a study published in 2015 5 highlights the importance of pharmacists assessing older adult drug regimens and recognizing potential drug interactions associated with proserotonergic drugs, such as trazodone and escitalopram. Another study published in 2015 6 reviews the pharmacology and risk factors for serotonin syndrome associated with tramadol, but also provides relevant information on the importance of monitoring for serotonin syndrome when using serotonergic medications, such as trazodone and escitalopram.