What patient education should be provided for trazodone?

Patient Education for Trazodone

Patients prescribed trazodone must understand that this medication is FDA-approved only for depression, not insomnia, and carries a black box warning for increased suicidal thoughts and behaviors, particularly in those under age 25. 1

Critical Safety Warnings

Suicidal Thoughts and Behaviors

• Watch for new or worsening depression, suicidal thoughts, or unusual behavior changes, especially during the first few weeks of treatment or after dose changes. 1
• Patients and caregivers should immediately report any emergence of suicidality to their healthcare provider. 1
• This risk is highest in children, adolescents, and young adults under 25 years of age. 2

Priapism (Medical Emergency)

• Priapism is a prolonged, painful erection lasting more than 4 hours that requires immediate emergency medical attention. 2
• This rare but serious side effect may require surgical intervention if not treated promptly. 2
• Patients should go to the emergency room immediately if this occurs. 3

Serotonin Syndrome

• Avoid combining trazodone with other serotonergic medications (SSRIs, SNRIs, triptans, tramadol, St. John's Wort, MAOIs) without physician supervision. 1
• Warning signs include agitation, hallucinations, rapid heart rate, fever, excessive sweating, shivering, muscle twitching, nausea, vomiting, and diarrhea. 1
• Contact your healthcare provider or go to the emergency room if these symptoms develop. 1

Proper Administration

Timing and Food

• Take trazodone shortly after a meal or light snack, not on an empty stomach. 1
• For insomnia use specifically, some sources suggest taking it at least 1 hour before bedtime on an empty stomach to maximize sleep effects, though this contradicts FDA labeling. 4
• Allow a full 7-8 hours for sleep to reduce next-day drowsiness and impairment. 4

Dosing Instructions

• Never adjust your dose without consulting your physician—follow the prescribed titration schedule exactly. 1
• For insomnia, typical starting doses are 25-50 mg at bedtime, well below the 150-300 mg range needed for depression treatment. 4, 5
• Do not abruptly stop trazodone; work with your provider to taper gradually to avoid withdrawal symptoms. 1

Common Side Effects

Expected Adverse Effects

• Drowsiness and daytime sedation are the most common side effects, reported in 23% of patients versus 8% on placebo. 5
• Headache occurs in approximately 30% of patients. 5
• Dizziness and orthostatic hypotension (lightheadedness when standing) are common, especially in elderly patients. 3, 5
• Dry mouth may occur but is less severe than with older antidepressants. 6

Managing Side Effects

• Rise slowly from sitting or lying positions to minimize dizziness. 3
• Avoid driving or operating machinery until you know how trazodone affects you. 4
• Report persistent or severe side effects to your healthcare provider. 1

Important Drug and Substance Interactions

Avoid Alcohol and CNS Depressants

• Do not consume alcohol while taking trazodone—the combination significantly increases sedation and respiratory depression risk. 4
• Combining trazodone with opioids (hydrocodone, oxycodone) carries an FDA black box warning for potentially fatal respiratory depression. 4
• Benzodiazepines combined with trazodone increase oversedation risk. 4

Bleeding Risk

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

Other Medications

• Tell your healthcare provider about all prescription and over-the-counter medications you are taking, as many drugs interact with trazodone. 1

Special Population Warnings

Elderly Patients

• Older adults are at higher risk for falls, orthostatic hypotension, and excessive daytime drowsiness. 4, 5
• Lower doses (maximum 300-400 mg/day) are typically used in elderly patients. 5

Pregnancy and Nursing

• Notify your healthcare provider immediately if you become pregnant or plan to become pregnant while taking trazodone. 1
• Trazodone should be avoided during pregnancy and breastfeeding. 4
• A pregnancy exposure registry exists to monitor outcomes in women exposed to trazodone during pregnancy. 1

Patients with Medical Conditions

• Use extreme caution if you have compromised respiratory function (asthma, COPD, sleep apnea), liver disease, or heart failure. 4, 2
• Patients with cardiovascular disease require close monitoring for arrhythmias and blood pressure changes. 6

Monitoring and Follow-Up

Regular Assessment

• Expect follow-up appointments every 1-2 weeks initially to assess effectiveness, side effects, and suicidal ideation. 2
• Your provider will use the lowest effective dose for the shortest duration possible. 4
• Regular reassessment determines whether continued therapy is necessary. 4

Signs Requiring Immediate Medical Attention

• Prolonged painful erection (priapism). 2
• Signs of serotonin syndrome (fever, agitation, confusion, rapid heart rate). 1
• New or worsening suicidal thoughts. 1
• Slow or difficult breathing, extreme drowsiness, difficulty waking (especially if taking opioids). 4
• Complex sleep behaviors (sleepwalking, sleep-driving). 4

Discontinuation

• Never stop trazodone abruptly—withdrawal symptoms can occur. 1
• Work with your healthcare provider to develop a tapering schedule when discontinuing the medication. 1
• Adverse reactions during discontinuation should be reported immediately. 1

Realistic Expectations for Insomnia Use

Limited Evidence for Sleep

• The American Academy of Sleep Medicine recommends against using trazodone for insomnia because benefits do not outweigh harms. 4, 5
• At 50 mg, trazodone reduces sleep onset by only 10 minutes and increases total sleep time by 22 minutes—below clinically meaningful thresholds. 5
• No improvement in subjective sleep quality has been demonstrated in clinical trials. 4, 5
• Trazodone is considered a third-line option only after FDA-approved sleep medications and cognitive behavioral therapy for insomnia (CBT-I) have failed. 4

When Trazodone May Be Appropriate

• When comorbid depression and insomnia exist together. 4
• When FDA-approved hypnotics have failed or caused intolerable side effects. 2
• When used in combination with a full-dose antidepressant for patients with both depression and insomnia. 4