Can trazodone (Desyrel) and aripiprazole (Abilify) be taken together?

Trazodone and Aripiprazole (Abilify) Combination Therapy

Yes, trazodone and aripiprazole (Abilify) can be safely taken together, and this combination is sometimes used clinically when patients have both insomnia and psychiatric conditions requiring an antipsychotic medication.

Pharmacological Compatibility

Trazodone and aripiprazole work through different mechanisms, making them pharmacologically compatible:

• Trazodone: A sedating antidepressant that acts primarily as a serotonin antagonist and reuptake inhibitor, commonly used at lower doses (25-100mg) for insomnia 1
• Aripiprazole (Abilify): A third-generation atypical antipsychotic with partial agonist activity at dopamine D2 receptors and serotonin 5-HT1A receptors, and antagonist activity at 5-HT2A receptors 2

Clinical Evidence Supporting Combination Use

The combination of these medications is supported by clinical guidelines and practice:

• Guidelines for insomnia management note that trazodone is commonly used at lower doses for sleep disturbances, even when patients are on other psychiatric medications 1
• In palliative care settings, trazodone (25-100 mg) is recommended as a first-line agent for insomnia, and can be used alongside other psychotropic medications 1
• For patients with psychiatric conditions requiring antipsychotic treatment, adding trazodone for sleep can be appropriate when insomnia is present 3

Potential Interactions and Monitoring

While the combination is generally safe, there are some considerations:

1. Additive CNS depression: Both medications can cause sedation, so the combination may enhance this effect 1
2. Sterol biosynthesis: Research suggests both medications can affect sterol biosynthesis in the brain, though the clinical significance of this finding is unclear 4
3. QT interval: Monitor for potential QT interval prolongation, especially in patients with cardiac risk factors 1

Dosing Recommendations

When using this combination:

• Trazodone: Start with 25-50 mg at bedtime for insomnia; can increase to 50-100 mg if needed 1
• Aripiprazole: Standard dosing (typically 5-15 mg daily) based on the psychiatric indication 2
• Timing: Administer trazodone at bedtime to maximize sleep benefits and minimize daytime sedation 1

Special Populations

Elderly Patients

• Lower starting doses of both medications are recommended
• Trazodone: Start at 25 mg at bedtime 3
• Aripiprazole: Start at 2.5 mg daily 3
• Monitor closely for falls, sedation, and orthostatic hypotension

Patients with Hepatic Impairment

• Dose adjustments may be necessary as both medications are metabolized in the liver
• More frequent monitoring for side effects is recommended

Potential Side Effects to Monitor

• Sedation/somnolence: Most common with this combination
• Orthostatic hypotension: Particularly with trazodone
• Akathisia: More common with aripiprazole 2
• Metabolic effects: Primarily with aripiprazole (weight gain, lipid changes)

Practical Recommendations

1. Start with lower doses of both medications when initiating the combination
2. Take trazodone at bedtime to maximize sleep benefits
3. Monitor for excessive sedation, especially during the first week
4. Avoid alcohol and other CNS depressants, which could enhance sedative effects 1
5. Regular follow-up to assess efficacy and side effects

Alternative Combinations

If this combination is not tolerated, consider:

• Mirtazapine instead of trazodone for sleep (has similar sedating properties) 5
• Non-pharmacological sleep interventions alongside aripiprazole

In conclusion, trazodone and aripiprazole can be safely used together with appropriate monitoring, and this combination may be particularly beneficial for patients with both insomnia and conditions requiring antipsychotic treatment.