From the Research
Trazodone can be used safely in patients with impaired renal function, though some caution is warranted. No specific dosage adjustment is required for mild to moderate renal impairment, but patients with severe renal dysfunction should start with a lower dose, typically 25-50 mg at bedtime, with gradual titration as needed. Close monitoring for side effects is important in these patients, particularly for excessive sedation, orthostatic hypotension, and prolonged QT interval. Trazodone is primarily metabolized by the liver, with less than 1% excreted unchanged in urine, which explains why it doesn't significantly accumulate in renal failure 1. However, some metabolites may accumulate in severe renal impairment, potentially increasing the risk of adverse effects. Elderly patients with reduced renal function should be monitored especially carefully, as they may be more sensitive to both therapeutic and adverse effects. Regular assessment of renal function is recommended during treatment, particularly in patients with fluctuating kidney function or those on other medications that might affect renal clearance. Key considerations for the use of trazodone in patients with renal impairment include:
- Starting with a lower dose in severe renal dysfunction
- Gradual titration as needed
- Close monitoring for side effects
- Regular assessment of renal function Given the most recent evidence, trazodone is a viable option for patients with impaired renal function, with appropriate caution and monitoring 1.