Are there interactions between trazodone and opioid (opiate) medication, as well as nonsteroidal anti-inflammatory drugs (NSAIDs) such as acetaminophen (Tylenol) or ibuprofen?

From the Guidelines

Trazodone can interact with opioid medications, potentially increasing sedation and central nervous system depression when taken together, and it is recommended to use caution and monitor for side effects when combining these medications 1. When considering the use of trazodone with opioid medications, it is essential to weigh the potential benefits against the risks of increased sedation and central nervous system depression.

• The combination of trazodone and opioids may cause excessive drowsiness, dizziness, confusion, and impaired coordination, which could increase the risk of falls or accidents.
• Patients taking both medications should use caution, especially when driving or operating machinery. Regarding NSAIDs like ibuprofen, there is a slight increased risk of bleeding when combined with trazodone, though this interaction is not as significant as with other antidepressants 1.
• Tylenol (acetaminophen) generally does not have significant interactions with trazodone and is often considered a safer pain relief option for patients on trazodone.
• If you need to take trazodone with any pain medication, it's best to start with lower doses and monitor for side effects.
• Always inform your healthcare provider about all medications you're taking, including over-the-counter drugs and supplements, to ensure safe medication management and appropriate dosing adjustments if needed. In terms of pain management, multimodal analgesia involving the use of different classes of analgesic medications, such as acetaminophen, NSAIDs, and opioids, can provide effective pain relief while minimizing the risks associated with individual medications 1.
• Acetaminophen is a valid and effective option for pain management, and its use in a multimodal regimen can reduce opioid-related side effects and improve postoperative outcomes 1.
• NSAIDs, such as ibuprofen, can also be effective in reducing pain and inflammation, but their use should be cautious in patients with certain medical conditions, such as bleeding disorders or kidney disease 1.

From the FDA Drug Label

Inform patients about the concomitant use of Trazodone Hydrochloride Tablets with aspirin, NSAIDs, other antiplatelet drugs, warfarin, or other anticoagulants because the combined use of drugs that interfere with serotonin reuptake and these medications has been associated with an increased risk of bleeding Trazodone Hydrochloride Tablets increase the risk of bleeding events. Concomitant use of aspirin, nonsteroidal anti-inflammatory drugs (NSAIDS), other antiplatelet drugs, warfarin, and other anticoagulants may add to this risk Using Trazodone Hydrochloride Tablets with certain other medicines can affect each other causing serious side effects Especially tell your healthcare provider if you take: ... nonsteroidal anti-inflammatory drugs (NSAIDS) aspirin

Interaction with Opiate Medication: There is no direct information in the provided drug labels about the interaction between trazodone and opiate medication. Interaction with NSAID, Tylenol, or Ibuprofen: The labels warn about the increased risk of bleeding when trazodone is used concomitantly with NSAIDs, aspirin, or other antiplatelet drugs 2, 2, 2.

From the Research

Interaction between Trazodone and Opiate Medication

• There is no direct evidence of interaction between trazodone and opiate medication in the provided studies.
• However, it is known that trazodone can be used to treat insomnia in patients taking other medications, including SSRIs 3.
• Opiate medications are sometimes used to treat severe or refractory acute pain, and trazodone may be used as an adjunctive medication in certain cases 4.

Interaction between Trazodone and NSAIDs

• There is no direct evidence of interaction between trazodone and NSAIDs in the provided studies.
• NSAIDs are commonly used to treat acute pain, and trazodone is not typically used for this purpose 4, 5.
• However, it is possible that trazodone and NSAIDs could be used concurrently in certain cases, such as when a patient is taking trazodone for depression and also requires NSAIDs for pain management.

Interaction between Trazodone and Tylenol or Ibuprofen

• There is no direct evidence of interaction between trazodone and Tylenol (acetaminophen) or ibuprofen in the provided studies.
• Acetaminophen and ibuprofen are commonly used to treat acute pain, and trazodone is not typically used for this purpose 4, 6, 5.
• However, it is possible that trazodone and these medications could be used concurrently in certain cases, such as when a patient is taking trazodone for depression and also requires acetaminophen or ibuprofen for pain management.