From the Guidelines
If you're experiencing a serious adverse reaction to trazodone, stop taking the medication immediately and seek emergency medical attention. Serious reactions may include serotonin syndrome (agitation, hallucinations, rapid heart rate, fever, muscle stiffness, coordination problems), priapism (painful erection lasting more than 4 hours), severe allergic reactions (rash, itching, swelling, severe dizziness, trouble breathing), or suicidal thoughts. Other concerning side effects include irregular heartbeat, fainting, unusual bleeding/bruising, or seizures. After emergency care, contact your prescribing doctor to discuss what happened and alternative treatment options. Trazodone works by affecting serotonin levels in the brain, which helps with depression and sleep, but this mechanism can sometimes lead to adverse effects, as noted in studies such as 1 and 1. Never stop trazodone suddenly without medical guidance as this can cause withdrawal symptoms. Your doctor may need to gradually taper your dose or switch you to a different medication class entirely depending on the nature and severity of your reaction. Some key points to consider when managing adverse reactions to trazodone include:
- Monitoring for signs of serotonin syndrome, which can be life-threatening 1
- Being aware of the potential for increased risk of suicidal thoughts, particularly in the early stages of treatment 1
- Recognizing the importance of gradual dose tapering to avoid withdrawal symptoms when stopping trazodone 1
From the FDA Drug Label
- Adverse Reactions The following serious adverse reactions are described elsewhere in the labeling: Suicidal Thoughts and Behavior in Children, Adolescents and Young Adults [see BOXED WARNING and WARNINGS AND PRECAUTIONS (5.1)] Serotonin Syndrome [see WARNINGS AND PRECAUTIONS (5.2)] Cardiac Arrythmias [see WARNINGS AND PRECAUTIONS (5. 3)] Orthostatic Hypotension and Syncope [see WARNINGS AND PRECAUTIONS (5.4)] Increased Risk of Bleeding [see WARNINGS AND PRECAUTIONS (5.5)] Priapism [see WARNINGS AND PRECAUTIONS (5.6)] Activation of Mania or Hypomania [see WARNINGS AND PRECAUTIONS (5.7)] Discontinuation Syndrome [see WARNINGS AND PRECAUTIONS (5.8)] Potential for Cognitive and Motor Impairment [see WARNINGS AND PRECAUTIONS (5. 9)] Angle-Closure Glaucoma [see WARNINGS AND PRECAUTIONS (5.10)] Hyponatremia [see WARNINGS AND PRECAUTIONS (5.11)]
Trazodone Hydrochloride Tablets can cause serious side effects or death, including: See “What is the most important information I should know about Trazodone Hydrochloride Tablets? ” Serotonin syndrome. Symptoms of serotonin syndrome include: agitation, hallucinations, and problems with coordination, fast heartbeat, tight muscles, trouble walking, sweating, fever, nausea, vomiting, and diarrhea. Irregular or fast heartbeat or faint (QT prolongation) Low blood pressure You feel dizzy or faint when you change positions (go from sitting to standing) Unusual bruising or bleeding Erection lasting for more than 6 hours (priapism) Feeling high or in a very good mood, then becoming irritable, or having too much energy, feeling like you have to keep talking or do not sleep (mania). Withdrawal symptoms Symptoms of withdrawal can include anxiety, agitation, and sleep problems.
The serious adverse reactions to trazodone include:
- Serotonin syndrome
- Cardiac arrhythmias
- Orthostatic hypotension and syncope
- Increased risk of bleeding
- Priapism
- Activation of mania or hypomania
- Discontinuation syndrome
- Potential for cognitive and motor impairment
- Angle-closure glaucoma
- Hyponatremia 2 2
From the Research
Serious Adverse Reactions to Trazodone
- Serotonin syndrome is a potentially life-threatening condition that can occur with the use of trazodone, particularly when combined with other medications that increase serotonin levels 3.
- The symptoms of serotonin syndrome include neuromuscular excitation, autonomic instability, and altered mental status, and can be fatal if left untreated 3.
- Trazodone can also cause other adverse effects, such as sedation, headache, sweating, weight changes, and gastrointestinal effects like nausea and vomiting, due to its serotonergic activity 4.
- Rare but potential cardiovascular adverse effects of trazodone include orthostatic hypotension, arrhythmias, and priapism, which require close monitoring 5.
- Overdose of trazodone can lead to severe hypotension, requiring aggressive fluid resuscitation, pressor support, and intensive care unit admission 6.
- Withdrawal symptoms can occur when trazodone is discontinued, even with gradual tapering, due to its effects on the serotonergic system and short half-life of its metabolites 7.
Management of Adverse Reactions
- Benzodiazepines can be used to treat serotonin syndrome caused by trazodone 3.
- Aggressive fluid resuscitation, pressor support, and intensive care unit admission may be necessary to manage severe hypotension caused by trazodone overdose 6.
- Trazodone should be tapered off at a very slow rate to minimize the risk of withdrawal symptoms 7.