Trazodone Can Cause Dizziness Due to Orthostatic Hypotension
Yes, trazodone commonly causes dizziness as a side effect, with orthostatic hypotension being a well-documented mechanism behind this symptom. According to the FDA drug label, orthostatic hypotension and syncope are specifically listed adverse effects of trazodone therapy 1.
Evidence for Trazodone-Induced Orthostatic Hypotension
FDA Drug Label Information
The FDA drug label for trazodone explicitly states: "Hypotension, including orthostatic hypotension and syncope has been reported in patients receiving trazodone hydrochloride" 1. This represents the strongest regulatory evidence confirming this association.
Clinical Studies
In a clinical study of veterans prescribed trazodone:
- 60% of patients who tolerated trazodone reported side effects
- Dizziness was among the most common side effects, along with daytime sedation, headache, priapism, and orthostatic hypotension 2
- 19% of patients discontinued trazodone due to side effects
Mechanism of Orthostatic Hypotension with Trazodone
Trazodone's orthostatic hypotension effect is related to its:
- Alpha-adrenergic blocking properties
- Vasodilatory effects
- Impact on autonomic nervous system regulation
When a person changes position from lying or sitting to standing, trazodone can interfere with the normal compensatory vasoconstriction response, leading to blood pooling in the lower extremities and reduced cerebral perfusion 3.
Risk Factors for Trazodone-Induced Orthostatic Hypotension
The risk of experiencing orthostatic hypotension with trazodone is higher in:
- Elderly patients 3, 4
- Patients with pre-existing cardiovascular disease 4
- Patients taking other medications that can lower blood pressure 1
- Higher doses of trazodone (dose-dependent effect) 2
Clinical Implications and Management
Monitoring
- Blood pressure should be monitored, especially when initiating therapy or adjusting doses
- Orthostatic vital signs should be checked in patients reporting dizziness
- Particular vigilance is needed in elderly patients or those with cardiovascular conditions
Dose Considerations
- Start with lower doses in high-risk patients (elderly, cardiovascular disease)
- Typical dosing range is 25-600 mg, with a mean of 212 mg in studies 2
- Consider once-daily formulations which may provide improved tolerability 5
Concomitant Medications
- "Concomitant use with an antihypertensive may require a reduction in the dose of the antihypertensive drug" 1
- Review all medications that could potentiate hypotensive effects
Other Important Considerations
Additional Cardiovascular Concerns
Beyond orthostatic hypotension, trazodone has been associated with:
- QT interval prolongation
- Cardiac arrhythmias
- Torsade de pointes (particularly in overdose) 6
Other Common Side Effects
Alongside dizziness and orthostatic hypotension, common adverse effects include:
Conclusion
Orthostatic hypotension is a well-established side effect of trazodone that can manifest as dizziness. This effect appears in the FDA drug label and multiple clinical studies. Clinicians should be aware of this risk, particularly in vulnerable populations such as the elderly or those with cardiovascular disease, and should monitor patients accordingly.