Can trazodone (antidepressant medication) cause hypotension (low blood pressure)?

From the Guidelines

Trazodone can cause hypotension (low blood pressure) as a side effect, particularly when starting the medication, increasing the dose, or taking higher doses, due to its alpha-1 adrenergic receptor blocking activity, which leads to blood vessel dilation and decreased blood pressure. This effect is most pronounced when changing positions quickly, resulting in orthostatic hypotension, with symptoms including dizziness, lightheadedness, or fainting 1. To minimize this risk, doctors typically start with a low dose and gradually increase it, often recommending trazodone be taken at bedtime. Patients should rise slowly from sitting or lying positions, stay well-hydrated, and avoid alcohol, which can worsen this effect. Elderly patients and those taking other medications that lower blood pressure are at higher risk for this side effect.

Some key points to consider when prescribing trazodone include:

• Starting with a low dose (such as 25-50mg) and gradually increasing it as needed and tolerated
• Recommending patients take trazodone at bedtime to minimize the risk of orthostatic hypotension
• Advising patients to rise slowly from sitting or lying positions to reduce the risk of dizziness or fainting
• Encouraging patients to stay well-hydrated and avoid alcohol, which can exacerbate hypotension
• Monitoring patients, especially the elderly and those on other blood pressure-lowering medications, for signs of hypotension and adjusting the dose as necessary

It's also important to note that while the provided guidelines 1 discuss various antihypertensive medications and their potential side effects, they do not specifically mention trazodone. However, the mechanism of action of trazodone and its potential to cause hypotension is well-documented, and healthcare providers should be aware of this risk when prescribing the medication, particularly in vulnerable populations such as the elderly or those with cardiovascular disease 1.

From the FDA Drug Label

PRECAUTIONS General Hypotension, including orthostatic hypotension and syncope, has been reported to occur in patients receiving trazodone hydrochloride. Concomitant administration of antihypertensive therapy with trazodone hydrochloride may require a reduction in the dose of the antihypertensive drug

• Trazodone can cause hypotension, including orthostatic hypotension and syncope.
• The drug label also mentions that concomitant administration of antihypertensive therapy with trazodone may require a reduction in the dose of the antihypertensive drug 2.
• Additionally, the drug label lists hypotension as a possible adverse reaction, with an incidence of 7.0% in inpatients and 3.8% in outpatients 2.
• Orthostatic hypotension and syncope are also listed as possible cardiovascular system effects 2.

From the Research

Trazodone and Blood Pressure

• Trazodone, an antidepressant medication, has been found to have hypotensive effects, particularly in older adults 3, 4, 5, 6.
• Studies have shown that trazodone can cause a significant drop in blood pressure, especially when standing up, which can lead to orthostatic hypotension and increase the risk of falls and syncope 3, 4.
• The prevalence of orthostatic hypotension was found to be higher in patients receiving trazodone, with a significant association between trazodone use and the risk of syncope and falls 3, 4.
• Trazodone has been reported to produce less postural hypotension than most other antidepressants, but it can still cause significant hypotension in some patients, particularly at higher doses 5, 7.

Mechanism and Risk Factors

• The exact mechanism of trazodone-induced hypotension is not fully understood, but it is thought to be related to its alpha-adrenergic blocking properties and its ability to decrease peripheral resistance 5, 7.
• Risk factors for trazodone-induced hypotension include older age, hypertension, and concomitant use of other medications that can cause hypotension, such as antihypertensives and sedatives 3, 4, 6.
• Patients with pre-existing cardiovascular disease, such as ventricular irritability, should be cautious when taking trazodone, as it may worsen their condition 7.

Clinical Implications

• Healthcare providers should be aware of the potential for trazodone to cause hypotension and monitor patients closely, especially older adults and those with hypertension or cardiovascular disease 3, 4, 6.
• Patients taking trazodone should be advised to rise slowly from a sitting or lying position and to report any symptoms of hypotension, such as dizziness or lightheadedness 3, 4.
• The dose of trazodone should be adjusted carefully, and patients should be monitored regularly for signs of hypotension and other adverse effects 5, 7.