Can 75mg of Trazodone (triazolopyridine antidepressant) cause tremors?

Trazodone and Tremors: Clinical Evidence and Management

Yes, 75mg of trazodone can cause tremors as this is a documented adverse effect listed in the FDA drug label. 1

Evidence for Trazodone-Induced Tremors

• The FDA drug label for trazodone specifically lists tremors as an adverse reaction, occurring in approximately 3-5% of patients taking the medication 1
• Tremors are listed among the neurological adverse effects that can occur even at therapeutic doses, not just in overdose situations 1
• According to Praxis Medical Insights, trazodone can cause tremors, with cardiac patients potentially at higher risk for both movement disorders and cardiac arrhythmias 2
• A recent case report (2022) documented trazodone-induced parkinsonism in a 78-year-old male, which included coarse tremors of the upper extremities that resolved within a week after discontinuation of the medication 3

Mechanism of Trazodone-Induced Tremors

• Trazodone is a serotonin receptor antagonist and reuptake inhibitor (SARI) that affects multiple neurotransmitter systems 4
• The exact mechanism for tremor induction is not fully understood, but likely involves the interaction between serotonergic and dopaminergic systems 3
• At low doses, trazodone acts as a serotonin antagonist, while at higher doses it functions as a serotonin agonist, which may contribute to its neurological side effects 5

Risk Factors for Developing Tremors on Trazodone

• Elderly patients may be at higher risk for developing movement disorders including tremors 3
• Patients taking medications that may interact with trazodone's metabolism (such as amiodarone) could experience higher blood levels and increased risk of adverse effects including tremors 3
• Polypharmacy can amplify the adverse effects of trazodone that might not be commonly observed in routine practice 3

Management of Trazodone-Induced Tremors

• If tremors develop while taking trazodone, discontinuation of the medication should be considered, as symptoms may resolve within days to weeks after stopping the drug 3
• For patients requiring antidepressant therapy who develop tremors on trazodone, the American Academy of Family Physicians recommends considering switching to agents with lower reported incidence of movement disorders 2
• Dose reduction might be considered before complete discontinuation, especially if the patient is experiencing beneficial effects from trazodone 4
• Monitoring for other extrapyramidal symptoms is important, as tremors may be part of a broader movement disorder 3

Other Important Considerations

• Trazodone can cause additional neurological adverse effects including incoordination (5%), muscle twitches, numbness, and paresthesia 1
• The medication can also cause cardiac arrhythmias, including QT prolongation and torsade de pointes, particularly in patients with pre-existing cardiac disease 1
• Orthostatic hypotension and syncope are other potential adverse effects that may accompany or be confused with tremors 1
• When prescribing trazodone, start with lower doses in elderly patients and those with hepatic impairment to minimize adverse effects 4

In conclusion, while trazodone is generally well-tolerated compared to some other antidepressants, tremors are a recognized adverse effect that can occur at therapeutic doses including 75mg. Patients experiencing tremors should be evaluated for potential discontinuation or switching to an alternative medication.