From the Research
Trazodone does not require dose adjustment in patients on dialysis, and the standard dosing can be used for patients undergoing hemodialysis or peritoneal dialysis, typically starting at 50-100 mg at bedtime for insomnia or 150 mg daily in divided doses for depression, with gradual increases as needed. This is based on the fact that trazodone is extensively metabolized by the liver, with less than 1% excreted unchanged in urine, making kidney function less critical for its clearance 1. Additionally, trazodone is not significantly removed by dialysis procedures due to its high protein binding (89-95%) 1. However, patients on dialysis may be more sensitive to side effects like orthostatic hypotension, so careful monitoring is recommended when initiating therapy. Start with lower doses in elderly dialysis patients and those with significant comorbidities, and adjust based on clinical response and tolerability.
Some key points to consider when prescribing trazodone to patients on dialysis include:
- Monitoring for side effects such as orthostatic hypotension, which may be more pronounced in this population 1
- Starting with lower doses in elderly or comorbid patients to minimize the risk of adverse effects 1
- Gradually increasing the dose as needed and tolerated by the patient 1
- Being aware of the potential for increased risk of serious adverse events, particularly cardiovascular events, as seen in a recent randomized clinical trial 2
It's also important to note that while trazodone may be effective for treating depression and insomnia in patients on dialysis, the evidence for its use in this population is limited, and more research is needed to fully understand its benefits and risks 3, 4.