Trazodone and Abilify (Aripiprazole) Are Not Contraindicated Together
Trazodone and Abilify can be safely used together in patients with psychiatric conditions, as there is no absolute contraindication to their combination. In fact, this combination is commonly employed in clinical practice for patients with bipolar disorder, depression with insomnia, or treatment-resistant depression.
Rationale for Combination Use
The combination of trazodone with aripiprazole addresses complementary therapeutic needs:
- Trazodone is frequently used as an adjunctive agent for insomnia in patients taking other psychotropic medications, including antipsychotics like aripiprazole 1, 2.
- Aripiprazole combined with mood stabilizers is an established treatment for acute mania and maintenance therapy in bipolar I disorder 3.
- Clinical practice guidelines for insomnia recommend sedating antidepressants like trazodone (along with atypical antipsychotics like quetiapine and olanzapine) as treatment options, indicating these drug classes are used together in clinical settings 4.
Clinical Considerations When Using This Combination
Dosing Strategy
- When trazodone is used adjunctively for insomnia (rather than as a primary antidepressant), lower doses are typically employed compared to antidepressant dosing 2.
- Antidepressant doses of trazodone are usually 150-300 mg/day, while hypnotic doses are often lower 1, 2.
Monitoring Requirements
Monitor for the following potential adverse effects when combining these medications:
- Sedation: Both agents can cause somnolence; the additive sedative effect may be beneficial for insomnia but could cause excessive daytime drowsiness 1, 5.
- Orthostatic hypotension: Trazodone carries risk of orthostatic hypotension, particularly in elderly patients or those with cardiovascular disease 1, 6.
- QT prolongation: Trazodone may infrequently cause QT interval prolongation and cardiac arrhythmias 1.
- Extrapyramidal symptoms: Aripiprazole increases risk of extrapyramidal side effects with long-term treatment 3.
Specific Clinical Scenarios Where This Combination Is Useful
Bipolar disorder with insomnia: Aripiprazole is FDA-approved for acute mania in adults, and trazodone addresses the common comorbid insomnia without the mood-destabilizing risks of benzodiazepines 4, 3.
Depression with inadequate response: When treating symptom clusters in depression, trazodone has demonstrated improvement in sleep scores and can be combined with other agents 4.
Anxiety and agitation: Trazodone's low liability for activating side effects and efficacy on psychomotor agitation make it useful in patients also requiring antipsychotic treatment 1, 2.
Common Pitfalls to Avoid
- Do not assume contraindication based on drug class overlap: While both medications affect serotonin systems, this does not constitute a contraindication but rather requires monitoring for additive effects 1, 5.
- Avoid using trazodone as monotherapy for bipolar depression: If the patient has bipolar disorder, ensure a mood stabilizer or antipsychotic (like aripiprazole) is the primary agent, with trazodone used adjunctively 4.
- Screen for cardiovascular risk factors: Given trazodone's potential for orthostatic hypotension and arrhythmias, assess cardiovascular status before initiating combination therapy 1, 6.