Can Trazodone (triazolopyridine antidepressant) cause tremors?

Trazodone and Tremors: Clinical Evidence and Management

Yes, trazodone can cause tremors, particularly in overdose situations, but tremors can also occur at therapeutic doses as a reported adverse effect. 1, 2

Mechanism and Evidence

• Trazodone is a triazolopyridine antidepressant that acts as a serotonin receptor antagonist and reuptake inhibitor (SARI), which can affect neurotransmitter systems involved in movement control 3

• According to FDA labeling, tremors are specifically listed among the adverse reactions occurring at an incidence of 3-5% in controlled clinical studies with trazodone, compared to 1-4% with placebo 1

• Tremors are more likely to occur in certain situations:

  • When trazodone is combined with other serotonergic medications (potentially causing serotonin syndrome) 1, 4
  • In overdose situations 5
  • In elderly patients or those with pre-existing neurological conditions 2

Types of Movement Disorders Associated with Trazodone

• Tremors: The most commonly reported movement-related side effect 1

• Parkinsonism: Case reports document trazodone-induced parkinsonism, particularly in older adults, presenting with:

  • Cogwheel rigidity
  • Shuffling gait
  • Coarse tremors of extremities 2

• Myoclonus: Reported particularly when trazodone is combined with other serotonergic medications like fluoxetine 4

• Other neurological effects: The FDA label also mentions incoordination (5% incidence), muscle twitches, and numbness/paresthesia as potential adverse effects 1

Risk Factors for Trazodone-Induced Tremors

• Age: Elderly patients appear more susceptible to neurological side effects 2

• Polypharmacy: Concomitant use of medications that:

  • Inhibit CYP3A4 (may increase trazodone levels) 1
  • Have serotonergic properties (may cause serotonin syndrome) 1, 4
  • Affect dopaminergic pathways 2

• Dosage: Higher doses increase risk of adverse effects, including tremors 1, 3

Clinical Implications and Management

• Monitoring: Patients starting trazodone should be monitored for the emergence of tremors or other movement disorders 1

• Dose adjustment: Consider dose reduction if tremors develop at therapeutic doses 1

• Discontinuation: In cases of severe tremors or development of parkinsonism symptoms, discontinuation of trazodone may be necessary 2

• Resolution timeline: Tremors and movement disorders typically resolve within days to a week after discontinuation 2

• Alternative medications: For patients requiring antidepressant therapy who develop tremors on trazodone, consider switching to agents with lower reported incidence of movement disorders 5

Special Considerations

• Cardiac patients: Trazodone has been implicated in cardiac arrhythmias including torsade de pointes, especially in overdose situations, which may complicate management of patients with tremors who also have cardiac issues 5, 1

• Drug interactions: Be particularly cautious when combining trazodone with other medications that might affect serotonergic systems or inhibit trazodone metabolism 1, 4

• Elderly patients: Lower starting doses and more careful monitoring are recommended due to increased susceptibility to adverse effects including tremors 2

In conclusion, while trazodone is generally considered to have a favorable side effect profile compared to many other antidepressants, tremors remain a recognized adverse effect that clinicians should monitor for, particularly in vulnerable populations or when using higher doses.