What instructions should be given to a patient when prescribing trazodone (antidepressant medication)?

Patient Instructions for Trazodone

Patients should take trazodone shortly after a meal or light snack, on a regular nightly schedule rather than as-needed, starting at a low dose that will be gradually increased based on response and tolerability. 1, 2

Timing and Food Requirements

• Take trazodone shortly after a meal or light snack to optimize absorption and reduce side effects 1
• Administer at bedtime as a single daily dose, which is equally effective as divided dosing and reduces daytime drowsiness 3, 2
• The American Academy of Sleep Medicine emphasizes that trazodone should be taken on a regular schedule, not as-needed, for optimal therapeutic benefit and safety 2

Starting Dose and Titration

• Initial dose is typically 25-50 mg at bedtime for insomnia or sleep disturbances 4, 5
• For depression, the FDA-approved starting dose is 150 mg/day in divided doses, though lower doses (100 mg) may be initiated with gradual increases 1, 5
• Expect dose increases every 3-7 days by 50-100 mg increments based on response and side effects 1, 5
• Allow 4-8 weeks at therapeutic dose before concluding the medication is ineffective 5

How to Take the Medication

• Tablets can be swallowed whole or broken along the score line if a half-tablet dose is prescribed 1
• Do not crush or chew the tablets unless specifically instructed 1

Important Safety Warnings

Suicidal Thoughts

• Watch for emergence of suicidal thoughts or behaviors, especially during the first few weeks of treatment or when doses are changed 1
• Report any worsening depression, unusual changes in behavior, or thoughts of self-harm immediately to your healthcare provider 1

Serotonin Syndrome Risk

• Be alert for serotonin syndrome symptoms: agitation, confusion, rapid heart rate, high blood pressure, dilated pupils, muscle rigidity, sweating, diarrhea, or tremor 1
• This risk increases when trazodone is combined with other serotonergic medications including SSRIs, SNRIs, triptans (migraine medications), tramadol, St. John's Wort, or MAOIs 1
• Seek emergency care immediately if you experience these symptoms 1

Bleeding Risk

• Inform your provider if you take aspirin, NSAIDs (ibuprofen, naproxen), antiplatelet drugs, warfarin, or other blood thinners, as trazodone may increase bleeding risk when combined with these medications 1

Mania/Hypomania Activation

• Report any symptoms of mania or hypomania: unusually elevated mood, racing thoughts, decreased need for sleep, impulsive behavior, or excessive energy 1
• This is particularly important if you have a personal or family history of bipolar disorder 1

Common Side Effects to Expect

• Drowsiness/sedation is the most common side effect and may be most pronounced when starting treatment 6, 7
• Other frequent effects include headache, dizziness, and dry mouth 6
• Dizziness upon standing (orthostatic hypotension) can occur, especially in elderly patients—rise slowly from sitting or lying positions 6, 7

Critical Warnings

Priapism (Medical Emergency)

• Priapism (prolonged, painful erection) is rare but serious, occurring in approximately 1 in 6,000 male patients 6
• Seek immediate emergency care if an erection lasts more than 4 hours, as permanent damage can occur 6

Drug Interactions

• Tell your healthcare provider about ALL medications you take, including over-the-counter drugs, supplements, and herbal products 1
• Avoid MAOIs (certain antidepressants and other medications like linezolid) within 14 days before or after taking trazodone 1
• If taking strong CYP3A4 inhibitors (like ketoconazole, ritonavir) or inducers (like rifampin, carbamazepine), dose adjustments may be necessary 1

Discontinuation Instructions

• Never stop trazodone abruptly—withdrawal symptoms can occur 1, 2
• Work with your provider to taper gradually over 10-14 days when discontinuing 5, 1
• The American Academy of Family Physicians recommends tapering to minimize withdrawal effects 5

Duration of Treatment

• Full therapeutic effect requires 4-8 weeks at an adequate dose 5
• After 9 months of successful treatment, your provider may consider dose reduction to reassess whether continued medication is needed 5

Special Considerations

For Elderly Patients

• Lower starting doses (25-50 mg) are recommended for older adults 2
• Increased monitoring for orthostatic hypotension and falls is important 7

Pregnancy and Breastfeeding

• Notify your healthcare provider if you become pregnant or plan to become pregnant while taking trazodone 1
• A pregnancy exposure registry is available to monitor outcomes in women exposed to trazodone during pregnancy 1

Common Pitfalls to Avoid

• Do not use trazodone only as a sleep aid without addressing underlying depression or anxiety if present 2
• Do not take as-needed—regular nightly dosing is essential for safety and effectiveness 2
• Do not combine with alcohol, as this can increase sedation and other side effects 6
• Do not drive or operate machinery until you know how trazodone affects you, especially during initial treatment 6