From the Guidelines
Trazodone is a viable option for managing agitation in elderly patients and those with dementia, particularly when used at low doses (25-100mg) and as part of a comprehensive care plan. The American Psychiatric Association practice guideline recommends that nonemergency antipsychotic medication should only be used for the treatment of agitation or psychosis in patients with dementia when symptoms are severe, are dangerous, and/or cause significant distress to the patient 1. Trazodone, which works primarily by blocking serotonin receptors and has sedative properties, can help reduce nighttime agitation and improve sleep without the risks associated with antipsychotics or benzodiazepines.
When prescribing trazodone, it is essential to start with a low dose of 25mg at bedtime and titrate slowly, as elderly patients are more sensitive to side effects, such as dizziness, sedation, and orthostatic hypotension, which can increase fall risk 1. Cardiac monitoring may be necessary due to potential QT prolongation. The guideline also recommends reviewing the clinical response to nonpharmacological interventions prior to nonemergency use of an antipsychotic medication to treat agitation or psychosis in patients with dementia 1.
Some key points to consider when using trazodone for agitation in elderly patients and those with dementia include:
- Starting with a low dose and titrating slowly to minimize side effects
- Monitoring for cardiac effects, such as QT prolongation
- Using trazodone as part of a comprehensive care plan that includes non-pharmacological approaches to address underlying causes of agitation
- Considering the potential benefits and risks of trazodone compared to other treatment options, such as antipsychotics or benzodiazepines 1.
Overall, trazodone can be a useful option for managing agitation in elderly patients and those with dementia, but it should be used judiciously and as part of a comprehensive care plan that prioritizes non-pharmacological approaches and minimizes the risk of adverse effects.
From the Research
Role of Trazodone in Managing Agitation
- Trazodone, a triazolopyridine antidepressant, is used to manage agitation in elderly patients or those with dementia, although its efficacy and safety are still being studied 2, 3, 4, 5.
- Studies have compared trazodone to other medications, such as atypical antipsychotics and haloperidol, in terms of its effectiveness in reducing agitation and its side effect profile 2, 3, 5.
Efficacy of Trazodone in Managing Agitation
- A study found that trazodone was associated with similar rates of falls or major osteoporotic fractures compared to atypical antipsychotics, but had a lower rate of mortality 3.
- Another study reported that trazodone was partially or totally effective in more than 90% of participants using the drug, with the main reasons for prescription being agitation, insomnia, depression, and anxiety 4.
- A double-blind comparison of trazodone and haloperidol found that both medications were equally effective for treating overall agitated behaviors in patients with dementia, but specific symptoms may respond preferentially to a particular agent 5.
Side Effects and Safety of Trazodone
- Falls were the most frequent adverse event associated with trazodone use, reported in 30% of participants 4.
- Trazodone was found to have a relatively benign adverse-effect profile compared to haloperidol, with fewer adverse effects reported in the trazodone group 5.
- A study suggested that trazodone is not a uniformly safer alternative to atypical antipsychotics, given the similar risk of falls and fractures among older adults with dementia 3.
Clinical Use of Trazodone
- Trazodone is often prescribed for agitation, insomnia, depression, and anxiety in older adults with dementia 4.
- The medication may be used as an eclectic antidepressant for behavioral and psychological symptoms of dementia (BPSD) and insomnia, especially in older people with dementia 4.
- Clinicians should carefully consider the potential benefits and risks of trazodone when prescribing it for agitation in elderly patients or those with dementia 2, 3, 4, 5.