Trazodone is Not Indicated for Hypertension Management
Trazodone is not recommended or indicated for the management of hypertension (high blood pressure). 1
Trazodone's Approved Uses and Dosing
Trazodone is an antidepressant medication with the following characteristics:
- Trazodone is primarily used for depression, with typical adult dosages ranging from 150-400 mg daily in divided doses 2
- For depression, trazodone is often dosed at 150 mg predominantly at bedtime, increasing as needed to 200-300 mg for full antidepressant efficacy 3
- Trazodone is also used as a mood-stabilizing/antiagitation drug for managing problematic behaviors in conditions like Alzheimer's disease, with initial dosages of 25 mg per day up to a maximum of 200-400 mg per day in divided doses 1
- In elderly patients, maximum tolerated doses are typically 300-400 mg/day, while younger patients may tolerate up to 600 mg/day 4
First-Line Medications for Hypertension
For hypertension management, current guidelines recommend specific classes of medications that do not include trazodone:
- First-line antihypertensive medications include ACE inhibitors, ARBs, calcium channel blockers (CCBs), and thiazide/thiazide-like diuretics 1
- For most adults with hypertension, combination therapy is recommended, typically including a RAS blocker (ACE inhibitor or ARB) with either a dihydropyridine CCB or diuretic 1
- For Black adults with hypertension (without heart failure or chronic kidney disease), initial treatment should include a thiazide diuretic or CCB 1
- Beta-blockers are recommended when there are other compelling indications such as angina, post-myocardial infarction, or heart failure with reduced ejection fraction 1
Cardiovascular Effects of Trazodone
While trazodone is not indicated for hypertension, it does have some cardiovascular effects:
- Trazodone produces less postural hypotension than most other antidepressants and tends to lower heart rate 5
- It has little effect on cardiac conduction and does not worsen supraventricular arrhythmias 5
- Caution is warranted as trazodone can cause orthostatic hypotension, particularly at higher doses 4
- A case report documented a syncopal episode with hypotension and bradycardia when trazodone was combined with clonidine (an antihypertensive medication) 6
Conclusion for Clinical Practice
- For hypertension management, follow established guidelines using ACE inhibitors, ARBs, CCBs, or thiazide diuretics as first-line agents 1
- Trazodone should be reserved for its approved indications of depression and insomnia, not for blood pressure management 2, 3, 4
- If a patient with hypertension requires trazodone for depression or insomnia, monitor for potential hypotensive effects, especially when combined with antihypertensive medications 5, 4, 6