Trazodone Uses and Side Effects
Primary Indication
Trazodone is FDA-approved for treating major depressive disorder (MDD) in adults, with effective antidepressant doses typically ranging from 150-300 mg daily 1. The medication demonstrates comparable efficacy to tricyclic antidepressants, SSRIs, and SNRIs for treating depression 2, 3.
Clinical Uses
FDA-Approved Use
Common Off-Label Uses
While trazodone is frequently prescribed off-label for insomnia, the American Academy of Sleep Medicine (2017) specifically recommends AGAINST using trazodone for sleep onset or sleep maintenance insomnia 5. This represents a notable divergence between clinical practice patterns and guideline recommendations.
Despite this guideline recommendation, trazodone shows:
- Sedative and anxiolytic effects at low doses (25-75 mg) 4
- Potential benefits for insomnia in depressed patients specifically 2, 6
- Applications in anxiety disorders, behavioral disturbances in dementia, and neurological conditions 7, 8
Side Effects Profile
Most Common Side Effects
The FDA label identifies these frequent adverse effects 1:
- Swelling
- Blurred vision
- Dizziness
- Sleepiness/somnolence (particularly prominent compared to other antidepressants) 9
- Tiredness
- Diarrhea
- Stuffy nose
- Weight loss
- Nausea/vomiting
Serious Adverse Effects Requiring Immediate Medical Attention
Serotonin Syndrome 1:
- Agitation, hallucinations, coordination problems
- Fast heartbeat, tight muscles, trouble walking
- Sweating, fever, nausea, vomiting, diarrhea
Cardiac Effects 1:
- QT prolongation (irregular or fast heartbeat)
- Orthostatic hypotension (dizziness when changing positions)
- Risk increases with doses as low as 100 mg/day or less
Priapism 1:
- Erection lasting more than 6 hours
- Medical emergency requiring immediate treatment
Bleeding Risk 1:
- Unusual bruising or bleeding
- Increased risk when combined with NSAIDs, aspirin, or warfarin
Hyponatremia 1:
- Headache, weakness, confusion
- Trouble concentrating, memory problems, unsteady walking
Angle-Closure Glaucoma 1:
- Eye pain, vision changes
- Swelling or redness in or around the eye
Mania/Hypomania 1:
- Feeling high or very good mood, then becoming irritable
- Too much energy, excessive talking, decreased need for sleep
Withdrawal Symptoms 1:
- Anxiety, agitation, sleep problems
- Do not stop abruptly without medical supervision
Advantages Over Other Antidepressants
Trazodone has a notably favorable profile regarding 9, 2, 3:
- Low risk of sexual dysfunction (unlike SSRIs where paroxetine shows particularly high rates)
- Weight-neutral effects (unlike mirtazapine and paroxetine which cause significant weight gain)
- Minimal anticholinergic effects (no constipation, urinary retention, or dry mouth compared to tricyclics)
- Limited withdrawal symptoms
Critical Drug Interactions
Contraindicated or requiring extreme caution 1:
- MAOIs (must wait 2 weeks after stopping MAOI)
- Other serotonergic drugs (SSRIs, SNRIs, triptans, tramadol, St. John's Wort, tryptophan)
- Anticoagulants (warfarin, aspirin, NSAIDs) - increases bleeding risk
- CNS depressants and alcohol - potentiates sedation
Administration Guidelines
Dosing considerations 1:
- Take shortly after a meal or light snack
- Swallow whole or break in half along score line (do not crush or chew)
- If drowsiness occurs, timing adjustment may be needed
- Avoid alcohol and other CNS depressants
- Do not drive or operate machinery until effects are known
Special Populations
Boxed Warning: Increased risk of suicidal thoughts and behavior in children, adolescents, and young adults with MDD 1
Pregnancy: Unknown risk to unborn baby; pregnancy registry available (1-844-405-6185) 1
Breastfeeding: Passes into breast milk 1
Elderly patients: Higher risk of orthostatic hypotension 1