What is the use of Trazodone (Triazolopyringyl piperazine derivative)?

From the Guidelines

Trazodone should not be used as a treatment for sleep onset or sleep maintenance insomnia in adults, due to its adverse effect profile and lack of strong evidence supporting its efficacy for this indication. The most recent and highest quality study, published in 2020 in the Annals of Internal Medicine 1, advises against the use of trazodone for treatment of chronic insomnia disorder, citing its low-quality evidence supporting efficacy and substantial adverse effect profile.

Key Points

• Trazodone is a triazolopyringyl piperazine derivative with sedative properties, often used off-label for insomnia
• The American Academy of Sleep Medicine clinical practice guideline, published in 2017, also suggests that clinicians not use trazodone as a treatment for sleep onset or sleep maintenance insomnia in adults 1
• Common side effects of trazodone include drowsiness, dizziness, dry mouth, and blurred vision, while more serious but rare side effects include priapism
• For depression, trazodone is typically started at a dose of 150 mg daily, which can be gradually increased to 400 mg daily if needed

Clinical Considerations

• Patients with depression and sleep disturbances may benefit from alternative treatments that address both conditions
• Clinicians should carefully weigh the potential benefits and harms of trazodone and consider alternative treatments for insomnia, such as cognitive behavioral therapy for insomnia (CBT-I) or other pharmacologic agents with a more favorable risk-benefit profile
• The U.S. Food and Drug Administration has released a safety announcement on the risk for serious injuries caused by sleep behaviors associated with certain agents, including trazodone 1

From the FDA Drug Label

Trazodone Hydrochloride Tablets are indicated for the treatment of major depressive disorder (MDD) in adults. Trazodone Hydrochloride Tablets are a prescription medicine used in adults to treat major depressive disorder (MDD).

The use of Trazodone, a triazolopyringyl piperazine derivative, is for the treatment of major depressive disorder (MDD) in adults.

• The primary indication is for the treatment of MDD.
• It is not approved for use in children, as its safety and effectiveness in this population are unknown 2, 2.

From the Research

Uses of Trazodone

• Trazodone is a triazolopyridine derivative used for the treatment of major depressive disorder (MDD) in adults 3, 4.
• It is also used as an off-label hypnotic for the treatment of sleep disorders, including insomnia, in patients with MDD 5, 6, 4.
• Trazodone has anxiolytic and hypnotic activity, making it useful for patients with anxiety and insomnia 7.

Therapeutic Effects

• Trazodone has established efficacy in treating MDD, with comparable antidepressant activity to other drug classes, including tricyclic antidepressants, selective serotonin reuptake inhibitors, and serotonin-noradrenaline reuptake inhibitors 3, 4.
• It is effective in controlling a wide range of symptoms of depression, including insomnia, without the negative effects on sleep seen with SSRI antidepressants 3, 4.
• Trazodone has been used successfully in patients with depression and pre-existing cardiovascular disease 7.

Side Effects

• Common side effects of trazodone include somnolence, headache, dizziness, and dry mouth 3, 4.
• Less common side effects include orthostatic hypotension, minimal anticholinergic activity, corrected QT interval prolongation, cardiac arrhythmias, and rare occurrences of priapism and suicidal ideation 3, 4.
• Trazodone is relatively safe in overdose compared to other currently available agents, particularly tricyclic antidepressants 7.