- What You Need to Know About Trazodone for Sleep
- How Can Trazodone Help Me?
- Brand and Generic Names
- Before Taking Trazodone
- Allergy Information
- Common Interactions
- Adult Dosing
- Black Box Warnings
- Side Effects
- How Should I Take Trazodone for Sleep?
- What Do I Do If I Miss a Dose?
- What Happens If I Overdose?
- Efficacy Concerns
- Other Uses
- Typical Uses
- Off-label uses
- What is Trazodone and how does it work in dogs?
- When is Trazodone prescribed?
- Possible side effects of Trazodone
- Warnings and precautions
- Trazodone for Anxiety
- Trazodone Vs. Ambien: Uses, Side Effects, and Comparison
- Comparing Side Effects
- A Brief Comparison of Trazodone and Ambien as Sleep Aids
- Physical Dependence
- Which Is Best?
- What is Trazodone?
- Official Medical Uses of Trazodone
- Off-Label Medical Uses of Trazodone
- Side-Effects, Contraindications, and Potential Drug Interactions
- Forms and Dosage of Trazodone
- Trazodone for Sleep
- Trazodone in Veterinary Medicine
- Background of Trazodone in Veterinary Medicine
- Use in Veterinary Medicine
What You Need to Know About Trazodone for Sleep
Trazodone is principally an antidepressant, but it is also widely used to treat insomnia and to promote healthy sleep patterns. It does this both by causing drowsiness and by balancing the level of serotonin in the brain.
THIS ARTICLE IS FOR INFORMATIONAL PURPOSES ONLY AND SHOULD NOT BE TAKEN AS MEDICAL ADVICE. ALWAYS FOLLOW THE DIRECTIONS GIVEN BY YOUR DOCTOR WHEN TAKING ANY MEDICATION.
How Can Trazodone Help Me?
Trazodone can help you to re-establish a normal sleep pattern. Often, sleep disturbances are due to an imbalance in a natural chemical which is found in the brain. Serotonin is an important neurotransmitter which not only regulates our sleep. It is also related to our moods, appetite, and digestion, as well as our memory, sexual function, and desire. Insomnia can take different forms, and if you are not getting enough quality sleep it can seriously affect your health and your ability to perform your normal daily tasks. Trazodone is non-addictive, and it is quite inexpensive, which make it a popular choice for doctors to prescribe.
Trouble Falling Asleep
Trazodone makes you feel drowsy, and when taken before going to bed it can help you to drop off to sleep. If you have trouble falling asleep, you should take your Trazodone about three hours before bedtime.
Trouble Staying Asleep
If you wake up frequently during the night Trazodone can help you to sleep through the entire night. If you fall asleep easily, but then wake up again later, you should take your Trazodone about a half an hour before retiring.
Brand and Generic Names
Chemical name -Trazodone hydrochloride(HCL)
Generic name- Trazodone
Brand names- Desyrel, Oleptro, Trittico, Molipaxin, Trazorel (among others)
Before Taking Trazodone
Before prescribing Trazodone, your doctor will ask you if you have any allergies and what other medications you are taking. This is to make sure that the Trazodone will not cause an allergic reaction or interact with the other drugs. He will also ask you about your personal medical history and that of your immediate family. You should tell him if you or a family member have ever suffered from any kind of mental illness, particularly bipolar disorder, or if you or they have attempted suicide or had suicidal thoughts. You must mention if you or they have heart, kidney, or liver disease, blood pressure problems or a history of glaucoma. Also, if you have a history of substance abuse.
As Trazodone can cause dizziness, drowsiness and blurred vision, your doctor will advise you not to drive or use machinery until these symptoms pass. If you smoke marijuana, you should tell your doctor, as smoking marijuana or drinking alcohol can increase the dizziness which is sometimes experienced when taking Trazodone.
Tell your doctor about all the drugs you take both those that are prescribed or bought over the counter and including herbal or natural remedies. Make a list so that you do omit any.
Before prescribing Trazodone, your doctor may want to run some tests to rule out physical causes of your insomnia. Heartburn, pain, hot flushes, and side effects of drugs are all common causes of sleep disturbances.
Your doctor will ask you if you have any known allergies, and particularly if you are allergic to Nefazodone (Serzone).
Trazodone can affect the way other drugs that you are taking can react, and the way it reacts can be affected by other drugs in your system. These interactions can be dangerous, so it is very important that you tell your doctor about all the medicines you take both regularly or occasionally, whether they have been prescribed by a doctor, or you buy them directly in the pharmacy, or in a health food store. Remember that if you buy a new medicine to treat even a common complaint, you should tell your pharmacist that you are taking Trazodone for sleep, to make sure there is no risk of an adverse interaction.
The most commonly used medications which interact with Trazodone are digoxin and MAO inhibitors. Others are azole antifungals, HIV protease inhibitors, macrolide antibiotics, rifamycins, and, drugs used to treat seizures. The street drug Ecstasy or MDMA, the herb St John’s Wort, and some antidepressants also can cause interactions, as can antihistamines, muscles relaxants, and narcotic pain relievers, among others.
The adult dose of Trazodone for sleep is between 50-100 mg at bedtime. The tablet should be swallowed whole, and should not be crushed, snorted, or chewed. Eat a light snack before taking the tablet or take it with a meal. Frequently, you will be started on a low dose which your doctor may increase depending on your response to treatment. Be careful to follow the correct dosage and to take the tablet at the same time each night.
Black Box Warnings
A black box warning is a requirement of the FDA if reasonable evidence exists of a serious health hazard from using a drug. For Trazadone, the black box warning states that taking the drug can increase the chance of committing suicide. People aged less than 24 are at the greatest risk, and the risk of suicide increases when starting treatment, or changing the dosage.
Some people who take Trazadone may experience one or more side effects. Most of these are not serious. You may feel nausea and be sick or have diarrhea or sometimes constipation. You may experience drowsiness and tiredness or have blurred vision. Some people get headaches, muscle pain or a stuffy nose. Others feel dizzy or lightheaded, so remember to get up slowly from a sitting or lying posture, to reduce this. Occasionally weight changes can occur or a change in sexual interest or ability. Having an unpleasant taste in your mouth or having a dry mouth is quite common, and this can be relieved by sucking a hard sweet, or a piece of ice, chewing gum, or by drinking water. Most of these side effects will disappear after a period of using Trazodone, however, if any of them persist, or if they get worse, you should tell your doctor.
Occasionally severe side effects can occur, and if you experience any of the following conditions you should visit your doctor. If you have tremors or shaking, hear ringing in your ears or have nightmares. Also, if you have pains in your stomach, feel a shortness of breath, or have signs of an infection such as a high temperature or a persistent sore throat. Also, if you see blood in your urine or have trouble urinating.
Very serious side effects are uncommon, but if you experience any of the following symptoms you should seek medical help immediately. If you have pain in your left arm, jaw, or chest, have an irregular or fast heartbeat, experience seizures or fainting. Also, if you have pain in your eyes or they are swollen or red, if your pupils are wide, or if you have changes in your vision like seeing rainbows around the lights in the night time.
Rarely a serious condition called serotonin toxicity can occur and you should immediately see your doctor if you have severe dizziness, loss of coordination, hallucinations, muscle twitching, nausea, vomiting or diarrhea, or if you feel extreme agitation.
Very occasionally, men can experience a serious condition called priapism where the penis remains erect for more than four hours and causes pain. If this happens, do not take another dose of Trazodone and seek medical attention.
Allergic reactions to Trazodone are uncommon, but you should seek medical attention if you experience itching and a rash, and swelling, particularly if this is in the throat, tongue, or face. Also, if you have trouble breathing or feel very dizzy.
If at any time during treatment you feel aggressive, irritable, extremely worried, have a panic attack, get abnormally excited, act without thinking beforehand, or have suicidal thoughts, you should contact your doctor.
Older people are more susceptible to suffer from dizziness, drowsiness and abnormal heart rhythms and they should be carefully monitored.
How Should I Take Trazodone for Sleep?
Trazodone should be taken orally, that is by mouth. When taking Trazodone for sleep it is normal to be prescribed just one tablet a day. Take it a short while before you go to bed with a light snack. If you have trouble falling asleep, you should take it about three hours before bedtime. If you have trouble sleeping throughout the night, you should take it about 30-minutes before retiring.
Try to take it at the same time every night and only take the prescribed amount. It can take between two and four weeks before you will feel the full benefit of taking Trazodone. So, be patient and do not be tempted to increase the dosage as this will not make the drug work any faster or more effectively and it could be dangerous.
If, after a month of taking Trazodone, you do not find an improvement in your sleeping, or your condition has got worse, you should see your doctor. Do not stop taking this medicine unless your doctor tells you to. Stopping suddenly can make you feel anxious and agitated and will further disturb your sleep.
What Do I Do If I Miss a Dose?
If you forget to take a dose of Trazodone at the correct time take it as soon as you remember. However, if you go to bed and sleep, do not take the missed dose in the morning or take a double dose in the evening. Simply skip the dose and resume taking it as prescribed from then on.
What Happens If I Overdose?
Overdosing is caused by taking more than the prescribed dose at the correct times. It can cause irregular, slow, or rapid heartbeat, unusual dizziness, drowsiness, vomiting, difficulty in breathing, seizures, and a prolonged and painful penile erection in men. If you experience serious symptoms such as breathing difficulties or passing out, you should call 911 immediately. For other symptoms, you should call your local poison control center at 1-800-222-1222.
Short-term studies have shown that Trazodone can improve sleep after two weeks of treatment, but investigation into the long-term effects have not been performed. After six weeks of treatment, it is unclear as to how safe it is, or how well it works for treating chronic insomnia. Also, there is no established effective dosage for treating sleep problems, although lower dosages are generally given for this use.
In 2017, the treatment guidelines published by the American Academy of Sleep Medicine felt that due to so little research they could not recommend Trazodone for the treatment of chronic insomnia. However, data compiled recently has shown that people with insomnia have generally enjoyed an improvement in their condition while taking Trazodone.
As Trazodone is not classed as a controlled substance by the FDA as it has a very small risk of abuse or causing dependency, doctors can prescribe an unlimited number of pills to a patient. For this reason, many doctors believe that it is safer than many other sleep medications, but this is not backed up by scientific research as yet.
The FDA approved Trazodone for use as an antidepressant in 1981, but it has never been legally approved as a treatment for insomnia.
Trazodone should not be taken during pregnancy as it can harm the fetus and cause abnormal development. Be sure to tell your doctor if there is any chance that you are pregnant. It is unclear if Trazodone passes into the breast milk, but if you are breastfeeding a child you should inform your doctor.
Trazodone is not often used for the treatment of depression any more as more effective anti-depressants have been developed which have fewer side effects and have better success rates.
Depression, anxiety, and schizophrenia.
Insomnia in low doses.
Trazodone has been shown to be effective over the short term for both primary and secondary insomnia, in people both with and without depression. Although daytime sedation and some motor impairment can be experienced, side-effects are generally slight. Due to its low cost, and that it is not addictive, Trazodone remains a frequent off-label choice for treating insomnia and other sleep disturbances.
- Not a substitute for professional veterinary help.
Calm, peaceful, and content: these are all words we want to use when describing our dog when at home, going to a vet visit, or while traveling. So what should we do when we find ourselves using words like fearful, anxious, and destructive?
Especially, during times of separation, seasonal fireworks, car rides, or thunderstorms, our furry friends may suddenly exhibit signs of fear and anxiety resulting in accidents, destruction of property, and sleepless nights for you. In dealing with anxious behavior, the main objective is to reduce your dog’s anxiety and increase their well-being. And, of course, you also benefit when your dog is calm, peaceful, and content.
How do we get there? A prescription anti-anxiety medication, along with a behavioral modification training program, could make considerable improvements in your pet’s ability to cope with stressful events. This article will talk about a specific anti-anxiety medication, called Trazodone*, that could be helpful in those anxious times.
What is Trazodone and how does it work in dogs?
Trazodone HCl was first developed as an antidepressant for humans and used off-label for insomnia and post-traumatic stress. Since this medication has proven effective with a relatively safe profile, it has also been shown to be effective in dogs. It’s commonly prescribed to dogs (and cats) for anxiety, fear, and other anxiety-based behavioral disorders. It comes as an oral white tablet in different concentrations.
It is a Serotonin 2A antagonist/reuptake inhibitor and works by keeping Serotonin in the brain’s synaptic spaces for longer where it has an effect on mood. Serotonin is the “feel-good” neurotransmitter that’s associated with an increased sense of well-being and decreased aggression. When we have an imbalance of Serotonin in our brains, it’ll have an effect on our mood and behavior. Trazodone helps to maintain a healthy normal balance of Serotonin in the brain.
When is Trazodone prescribed?
The main objective of Trazodone administration is to minimize anxiety in short-term situations, as needed, or for generalized anxiety, administered daily. It’s also used for keeping patients calm during vet visits or while confined after orthopedic surgery.
It can be given to pets who are afraid of thunderstorms or fireworks. Trazodone is also given for separation anxiety-based behavior disorder with behavior modification training and it can be combined with certain other medications at your vet’s discretion to help relieve anxiety-based behaviors.
It’s best to give Trazodone before the trigger happens so that your dog is already calm when it begins to work. For example, if your dog is noise-averse and it’s 5 pm on July 4th, it’s a good time to start administering the Trazodone before the fireworks start instead of after the first boom.
Another example is before a vet visit: if your dog is usually fearful at the vet, a dose of Trazodone before you get ready to go will allow the medication to work in time for the car ride.
The time of onset and how long it lasts does vary from dog to dog, so it will be informative to do a practice test a day or two before a potentially fearful event, so you can optimize the timing. Trazodone is given every 8 hours and as needed based on the dog’s weight and response.
Possible side effects of Trazodone
In a recent study, Trazodone was found to be well-tolerated with minimal side effects in dogs.
Possible side effects include sedation, lethargy, gastrointestinal symptoms (vomiting and/or diarrhea), ataxia, priapism (prolonged erections), increased anxiety, and aggression. However, these symptoms are uncommon.
An unlikely but serious side effect called Serotonin Syndrome can occur when Trazodone is combined with other serotonin-enhancing drugs such as Fluoxetine and Clomipramine (anti-depressants). If you notice tremors/shivering, dilated pupils, or difficulty breathing, these can be signs of Serotonin Syndrome and you should take your dog to the vet immediately.
Trazodone has the advantage over other anti-anxiety medications of having the lowest seizure risk and fewer adverse effects.
Warnings and precautions
Trazodone can cause an allergic reaction, so dogs who are potentially hypersensitive to it should not be given this medication.
If your dog is on any MAO (monoamine oxidase) inhibitors such as Selegiline or Amitraz (used for mange treatment and tick control), then they shouldn’t be given Trazodone. Also, if your dog has any kidney, liver, or heart problems, then you should discuss using Trazodone with your veterinarian.
Any medication you administer to your pet can serve as a tool to enhance their well-being. Using an adjunctive medical therapy such as Trazodone, with a behavioral modification program is recommended for results in behavior changes.
With active communication with your vet about dosing, reporting any side effects, and consistency in your training, you’ll increase the likelihood of a positive outcome.
Resources for behavioral modification can be found at the following sites:
- Dr. Sophia Yin: Resources on Dog Behavior
- The Animal Behavior Society: Directory of Canine Behaviorists
- The Dog People: Dog Behavior Articles
*This article is meant for educational purposes only and not for prescribing purposes. Please do not administer medication without your veterinarian’s approval as serious side effects could occur without your veterinarian’s advice.
Trazodone for Anxiety
Many people wonder “is trazodone like Xanax?” What are their similarities and differences?
First, what is Xanax?
Xanax is not classified as an antidepressant but is instead a benzodiazepine. It’s a short-acting drug that works on certain neurotransmitters in the brain that are imbalanced in people with anxiety disorders including panic disorders, anxiety associated with depression, and generalized anxiety disorder.
Xanax is considered not just short-acting, but it is also used for as-needed anxiety situations, such as panic attacks.
When someone takes trazodone, it binds to the 5-HT2 receptor, and when it’s taken at high doses, it acts as a serotonin agonist. It’s believed to relieve symptoms of anxiety and depression by inhibiting serotonin reuptake. Xanax, on the other hand, binds to benzodiazepine receptors, and it increases the inhibition of GABA neurotransmitter activity in the brain. It significantly impacts the activity of the central nervous system in a way that trazodone doesn’t.
The chemical structure of trazodone and Xanax are very different from one another, as are the mechanisms of action.
Trazodone also works not just to relieve symptoms of anxiety and depression, but it also improves appetite, life outlook, mood and sleep. Xanax just has calming effects, and wouldn’t be a good treatment for someone with depression in most cases.
Another big difference between trazodone and Xanax is the fact that Xanax is very addictive. Trazodone may cause addiction, but not at the level of Xanax. If a patient is prone to drug abuse Xanax may not be an ideal option, whereas trazodone could work well.
The side effects of trazodone and Xanax can be similar to one another including weight gain, drowsiness, and dry mouth.
Trazodone Vs. Ambien: Uses, Side Effects, and Comparison
The term insomnia is a descriptive word as opposed to a formal medical term that is used to describe problems with sleep. Insomnia can be used to describe difficulty falling asleep, waking up during the night at some point and being unable to go back to sleep, and significant issues with fatigue and sleepiness after waking.
There are two primary divisions of insomnia.
- A person who has difficulty with sleep that is not caused by some other psychological or physical disorder would be categorized as having primary insomnia
- A person who has difficulty sleeping due to a medical condition or mental health disorder would be diagnosed with secondary insomnia.
The treatment for primary insomnia is simply to address the sleep issue, whereas the treatment for secondary insomnia would involve addressing the condition that is producing the insomnia and perhaps addressing the insomnia itself medically or behaviorally. Most people suffer from temporary insomnia at some point in their lives, and issues with temporary insomnia that resolve over time are usually not problematic.
Chronic insomnia is defined as insomnia that occurs at least three times a week and has been consistently occurring at least one month.
There are numerous medications designed to address issues with insomnia. Two of the more popular medications are Ambien (zolpidem) and Desyrel or Oleptro (trazodone).
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Ambien is a sedative or hypnotic (sleep-producing) drug that is prescribed primarily for the treatment of insomnia. Ambien has a mechanism of action that is similar to the mechanism of action of more potent tranquilizers/sedatives like benzodiazepines (e.g., Xanax or Valium).
Ambien is believed to work by increasing the availability of the primary inhibitory neurotransmitter in the brain and spinal cord GABA (gamma-aminobutyric acid). This neurotransmitter is a chemical that is released by the neurons in the brain and spinal cord (referred to as the central nervous system) that reduces the actions of other neurons in the brain. This leads to its ability to produce sedation.
Ambien works relatively quickly compared to many similar drugs, and it has a very short half-life (the time it takes the system to metabolize or reduce the concentration of a drug to half its original concentration). This means that Ambien works quickly, does not remain in the body very long, and can help to induce sleep with lower doses than similar drugs (e.g., benzodiazepines like Xanax). When individuals experience the type of insomnia that does not involve problems falling asleep, but instead involves waking up in the middle of the night and not being able to go back to sleep, higher doses of Ambien or an extended-release version may be used.
Trazodone is not a medication that is primarily designed to produce sleep (a sedative or hypnotic medication). Trazodone was developed as an antidepressant medication. It has an entirely different mechanism of action than Ambien.
Trazodone works by increasing the availability of the neurotransmitter serotonin in the CNS. It is categorized as a serotonin antagonist reuptake inhibitor (SARI), meaning that it primarily blocks the ability of neurons to reabsorb serotonin once it has been released into the central nervous system. This leaves serotonin available in the central nervous system for longer periods of time and theoretically addresses issues with depression.
Because of the chemical composition of trazodone, it has been found to have mild sedating effects, and it is less effective than other antidepressants for the treatment of depression. Therefore, trazodone has found greater utility as a sleep aid than it has as an antidepressant medication.
Comparing Side Effects
Side effects from Ambien use can include:
- Lethargy, drowsiness, and daytime sleepiness (particularly in elderly people)
- Dizziness, lightheadedness, and/or headache
- Nausea and diarrhea
- Problems with reaction times and coordination
- Problems with remembering new information, particularly the day after using the drug
- Rebound insomnia (insomnia that occurs when the person stops using the drug)
- Hallucinations (rare)
- Parasomnias (very rare), which are troubling disorders of sleep that occur when a person who is sound asleep begins engaging in activities that they would normally perform while they are awake, such as cooking, doing household chores, and even driving
- The development of physical dependence on Ambien (tolerance and withdrawal symptoms)
Common side effectsassociated with trazodone include:
- Nausea, vomiting, and diarrhea or constipation
- Dizziness, unsteadiness, dry mouth, and/or headache
- Fatigue, tingling or numbness in the extremities (arms and legs), or ringing in the ears
- Muscle pain, rash, tremors or shaking (mostly in the hands)
- Anxiety, difficulty with attention, decreased appetite, and weight loss
- Prolonged and painful erections in men
- Thoughts of harming oneself (most often in children or adolescents)
- Mild physical dependence
Both drugs have the risk for very rare and more serious side effects that would need to be addressed by a physician if they occur. Higher doses are more likely to produce more severe side effects. Trazodone is generally better tolerated in most people than Ambien because trazodone is not specifically designed to produce sedation. However, the actual side effects than any person will experience are difficult to predict, and physicians typically wait and see how the person reacts to the drug.
A Brief Comparison of Trazodone and Ambien as Sleep Aids
Ambien as a sleep aid:
- Is effective at helping people fall asleep quicker and stay asleep longer.
- Comes in an extended-release version that is effective at helping people stay asleep.
- Comes in generic versions (zolpidem) that are inexpensive.
There are some downsides to Ambien.
- It may produce next-day drowsiness or cognitive problems.
- People develop tolerance to Ambien quickly, meaning they need more of the drug over time for it to be effective.
- It has the potential to produce parasomnias.
- It is not indicated for people with a history of depression, respiratory problems, kidney disorders, or liver problems.
- It is very likely to produce physical dependence.
Trazodone as a sleep aid:
- Is commonly used to treat issues with sleep at lower doses.
- Is safer for elderly individuals than other sleep aids.
- Has fewer side effects than most drugs used as sleep aids.
- Does come in a generic version that is cheaper than Ambien.
There are some downsides to trazodone.
- If depression is the issue, higher doses are needed.
- Higher doses result in more side effects.
- Problems with sexual functioning (particularly males) and suicidality (particularly in younger people).
- It is less sedating than Ambien and may not be effective for everyone.
Both Ambien and trazodone use may produce a syndrome of physical dependence (withdrawal symptoms when the person cuts down on using the drug or stops using it altogether). The symptoms of withdrawal associated with Ambien include insomnia, anxiety, flulike symptoms, and stiffness or muscle cramps. The symptoms associated with antidepressant discontinuation syndrome (withdrawal from antidepressants like trazodone) include anxiety, depression, irritability, and mild flulike symptoms.
In general, both withdrawal syndromes are addressed by slowly tapering down the dosage of the drug over time to allow the system to get used to decreasing amounts and then finally discontinuing it altogether. The withdrawal syndrome associated with Ambien is considered to be more severe and more potentially serious than withdrawal from antidepressants like trazodone. Likewise, the potential to develop a withdrawal syndrome is higher with Ambien than it is with trazodone.
Which Is Best?
The data indicates that trazodone will most likely produce fewer side effects and complications than Ambien; however, trazodone may not help some individuals with sleeping. The choice of using trazodone or Ambien is really dependent on the particular needs of the person being treated, their medical history, and the other medications they are taking.
That being said, using medications to treat insomnia is not considered to be the best overall choice. Instead, using Cognitive Behavioral Therapy to help people sleep is a better long-term solution than the use of any medication. For instance, an article in TIME compared the effects of medications and psychotherapy, and came to the conclusion that Cognitive Behavioral Therapy is the best long-term solution to insomnia.
Thus, medications like Ambien, trazodone, and even natural substances like melatonin should only be used as temporary aids for sleep while an individual attempts to address the primary problem that is producing their sleep difficulties. Using behavioral techniques allow the person to address their issue, develop a program of healthy sleep, and continue to implement this program over the long-term without experiencing significant side effects.
Trazodone is an FDA-approved treatment for depression, anxiety, and some forms of insomnia. It is also sometimes used “off-label” to relieve certain symptoms of bulimia, dementia, and alcoholism. Read on to learn more about the various medical uses, mechanisms, and potential side-effects of this drug.
Disclaimer: This post is not a recommendation or endorsement for trazodone. This medication is only approved for the treatment of certain specific medical disorders, and can only be taken by prescription and with oversight from a licensed medical professional. We have written this post for informational purposes only, and our goal is solely to inform people about the science behind trazodone’s effects, mechanisms, and current medical uses.
What is Trazodone?
Trazodone is a sedative and antidepressant medication belonging to the class of serotonin receptor antagonists and reuptake inhibitors (SARIs). In simpler words, this means it has two main effects. For one, it prevents serotonin from being taken back up into neurons after it is released, which increases the total amount of serotonin available to the brain. Secondly, it also inhibits the activity of certain specific types of serotonin receptors (such as 5HT2a and 5HT2c) .
This medication has been approved for the treatment of depression, anxiety, and insomnia, which are its primary medical uses. It also has numerous “off-label” uses to treat conditions such as bulimia nervosa, aggressive behaviors, and sexual dysfunctions (“off-label” refers to when doctors use a drug to treat a health condition that a drug hasn’t been officially approved for).
Trazodone works rapidly, and the effects are often evident within the first week of treatment .
Not only is trazodone effective, but it also shows some key advantages over other antidepressants regarding therapeutic efficacy, due to its multifunctional properties (more on this below) .
Data suggests that trazodone has less potential for short-term abuse than other drugs like triazolam and zolpidem .
Mechanism Of Action
Trazodone is a dose-dependent multifunctional drug, meaning that it has more than one therapeutic mechanism. At low doses (50-100 mg) it acts as a hypnotic, while at higher doses (150-600 mg) it has antidepressant properties .
At low doses it:
- Blocks serotonin 5HT2 (5-HT2A and 5-HT2C), thus decreasing the arousing effect of serotonin and leading to an increase in slow-wave sleep / EEG slow-wave activity .
- Blocks α-adrenergic receptors, decreasing the arousing effect of noradrenaline .
- Blocks histamine H1 receptors, decreasing the arousing effect of histamine .
At high doses it:
- Blocks the serotonin reuptake transporter (SERT), which increases serotonin that stimulates 5-HT1A receptors exerting its antidepressant effects .
- Its active metabolite, methyl-chlorophenylpiperazine (mCPP), also stimulates 5-HT1A receptors, leading to wakefulness-promoting effects However, these effects might be variable due to genetic variability in mCPP-related genes which are relatively common in the general population .
Official Medical Uses of Trazodone
Trazodone has a number of primary medical uses, which have been fully approved by the FDA. Although this means that the evidence for its efficacy is very strong, always keep in mind that this is a prescription medication that must only be used under the direction and supervision of a qualified medical professional.
1) Helps Treat Depression
Major depressive disorder (MDD) is the leading cause of disability, affecting approximately 6.7% of the population in the US and over 350 million people worldwide. As an atypical antidepressant, trazodone is FDA-approved and frequently used to treat depression .
In various short-term trials, trazodone and mirtazapine were reported to be beneficial in treating patients with moderate-to-severe depression .
In a double-blind randomized controlled (DBRC) study of 108 patients between 20-28 years old, trazodone was found to be effective in reducing common symptoms of depression such as lack of sleep and motivation, and promoting recovery .
Another DBRC study of 127 patients with depression compared trazodone to amitriptyline and placebo. Trazodone outperformed the placebo in the treatment of depression and anxiety. Trazodone also produced fewer side effects than amitriptyline .
In another DBRC study comparing bupropion and trazodone, 124 patients were randomly assigned to receive one of these two medications. While the overall efficacy of the drugs was similar, the group that received trazodone had a significant improvement after only 7 days, most likely due to trazodone’s ability to promote better sleep .
2) Improves Insomnia
Prolonged insomnia increases the risk for depression, and insomnia is often treated with low-dose antidepressants like trazodone .
At low doses (50-100 mg), trazodone acts as a hypnotic, which helps treat sleep disorders .
Due to its sedative properties, it is the second-most commonly-prescribed medication for the treatment of insomnia .
Patients with Alzheimer’s disease also often suffer from sleep disorders. In a double-blind randomized controlled study, Alzheimer’s patients received either trazodone or placebo, and the results showed that trazodone significantly improved their sleep .
Trazodone also improved sleep quality in patients with other conditions, such as fibromyalgia and various mood disorders .
In a double-blind study of 6 men between 18-32 years old, trazodone significantly enhanced deep sleep .
3) Improves Anxiety and PTSD Symptoms
Anxiety disorder is characterized by worried or panicked feelings that are frequent, excessive, and difficult-to-control. It is often accompanied by depression, and is commonly treated in a similar manner .
Due to its hypnotic and sedative effects, trazodone has been used to treat various anxiety disorders .
In a study of 6 patients, trazodone reduced the intensity of PTSD symptoms including agitation, insomnia, severe anxiety, fear, and self-destructive behavior in 66% of the patients .
According to a survey of 60 PTSD patients, trazodone decreased nightmares and improved overall sleep in ~75% of patients .
Interestingly, trazodone also treats anxiety symptoms in animals and is, therefore, used in various veterinary practices. For example, according to one study, trazodone significantly improved anxiety in cats during transportation .
Off-Label Medical Uses of Trazodone
Occasionally, doctors will prescribe medications to help treat conditions that fall outside of the official uses approved by the FDA — also known as “off-label” drug use . Usually this is done because there is actually decent evidence that the drug may help, although this evidence might not be quite strong enough to get full FDA approval (which generally has very strict requirements).
As always, however, always remember that the decision to use medications in this way can only be made by a licensed medical professional.
1) Treating Alcoholism
When treating alcohol addiction with oral medication, the treatment primarily focuses on alleviating the withdrawal symptoms — which in the case of alcohol abuse and many other drugs can be quite severe .
Trazodone has shown to be effective in decreasing depressive and anxious symptoms as well as cravings for alcohol in patients with alcohol withdrawal symptoms for more than 35 years .
Trazodone was effective in treating 17 alcoholic patients’ withdrawal symptoms by blocking norepinephrine receptors .
One double-blind randomized controlled study of 16 patients with alcoholism suggested that trazodone is an option to treat post-withdrawal symptoms and prevent alcohol relapses .
In a study where both the researchers and the patients knew which medication was being administered, trazodone was reported to reduce relapse rates and helped maintain alcohol abstinence in 60% of the patients .
2) Treating Bulimia Nervosa
In a double-blind randomized controlled study of 42 women with bulimia nervosa, trazodone was reported to significantly decrease the frequency of binge eating and vomiting .
In 4 out of 10 patients, episodes of binge eating and vomiting completely disappeared, while in 2 of the patients, the episodes were decreased by 55-99%. Trazodone was also the preferred medication due to its relatively low toxicity compared to other drugs used to treat eating disorders .
Trazodone also contributed to the improvement of dental abnormalities and damaged throat, which are consequences of bulimia nervosa .
3) Treating Adjustment Disorders
An adjustment disorder is characterized by stress, sadness, hopelessness, and physical symptoms following an overreaction to a stressful event, probably due to an inability to cope.
The symptoms of adjustment disorders often overlap with those of major depressive disorder, and include prolonged feelings of hopelessness, lack of motivation, anxiety, sleep problems, and lack of energy. Due to these overlapping symptoms, antidepressants such as trazodone may have potential for treating adjustment disorders .
One prospective cohort study reported that after 56 days of trazodone therapy, 34 out of 52 patients showed improvements in symptoms of anxiety, self-esteem, insomnia, and aggressive behaviors .
Similarly, a double-blind randomized controlled study of 18 cancer patients diagnosed with adjustment disorder reported that trazodone was more successful in reducing stress, sleep disorders, and lack of appetite compared to clorazepate (another sedative) .
4) Treating Aggressive Behavior
Despite being a normal human behavior when in moderation, excessively emotional or impulsive forms of aggression are often treated with medications such as antidepressants, mood stabilizers, or antipsychotics to prevent self-harm .
Aggressive behaviors are thought to be at least partially caused by a deficiency of serotonin. By blocking serotonin reuptake, trazodone increases the amount of serotonin in the brain, thereby reducing aggression .
A study of 3 individual patients (with different levels of aggression) concluded that trazodone was effective for decreasing aggressive behavior in children. In each of the 3 cases studied, aggressive behaviors relapsed after treatment discontinuation, further demonstrating that trazodone was responsible for their improvement .
Aggressive and impulsive behaviors significantly improved in 13 out of 22 hospitalized children who were unresponsive to several other types of antidepressants .
Trazodone has long-term effects, and is used to control behavioral disturbances in children .
5) Canceling Out Sexual Side-Effects From SSRIs
Sexual dysfunction is one of the potential side-effects of antidepressant therapy. For example, selective serotonin reuptake inhibitors (SSRIs) have been reported to cause sexual dysfunctions in up to 70% of the users .
One of trazodone’s potential strengths is that, unlike many other common antidepressant medications, it doesn’t appear to cause these types of side-effects in the first place, making it a potentially superior treatment option for people who experience SSRI-related sexual dysfunction .
Additionally, a study in depression patients who were currently experiencing sexual dysfunction due to treatment with SSRIs reported that adding trazodone to their treatment caused these sexual side-effects to resolve, leading to a recovery of their normal sexual function .
6) Treating Symptoms of Dementia
Dementia causes a long progressive decline in cognition and overall functioning, and can be quite difficult to treat. Hence, other common symptoms of dementia — such as insomnia and aggression — are often treated instead .
In one randomized controlled trial of 26 dementia patients, trazodone significantly decreased irritability, agitation, depressive symptoms, and eating disorders in 10 of the patients .
In another study, 18 out of 22 dementia patients with behavioral complications showed significant improvement with trazodone. The authors of this study concluded that trazodone may have potential as an alternative to other common medications, such as neuroleptics or benzodiazepines .
Side-Effects, Contraindications, and Potential Drug Interactions
While trazodone is one of the more tolerable antidepressants, like any drug it is not without its share of potential side-effects.
As always, the only responsible way to minimize the risk of adverse side-effects is to discuss all treatment options with your doctor, and to take any medications they prescribe you exactly as directed.
Some common side-effects of trazodone include drowsiness, dizziness, stomach upset, vomiting, weakness, decreased alertness, weight loss, tremor, dry mouth, blurred vision, bowel movement disturbances, and delayed urine flow .
Less frequently, trazodone can cause the following severe side effects:
Like many antidepressants, people who are prescribed trazodone but later decide to stop taking it are generally advised to taper off gradually, rather than stopping all medication suddenly. This is done to minimize the potential of withdrawal symptoms, and is always done under the supervision of a doctor. Nonetheless, there have been some reported cases of withdrawal-like symptoms in patients who tapered off their use of trazodone . Although this generally rare, it is nevertheless something to be aware of if you are prescribed it.
As with many medications, there are some other factors that can interfere with taking trazodone, and which could cause potentially severe side-effects if not taken into account. For this reason, there are a few indicators that a person should actively avoid taking trazodone.
As always, the best way to avoid complications from trazodone is to use it only as directed by your doctor, who will take these potential factors into account when deciding whether or not to prescribe it for you.
Some of the known contraindications include :
- People taking monoamine oxidase inhibitors (MAOIs), such as linezolid and intravenous (IV) methylene blue should not take trazodone, due to an increased risk of serotonin syndrome (dangerously elevated levels of serotonin in the brain / nervous system).
- Caution should be used in those who have kidney and liver function impairment.
Use in Pregnancy and Breastfeeding
Trazodone has been reported to be safe during pregnancy and has not been found to increase the occurrence of birth defects. Although the exposure of babies to trazodone via breast milk is minimal, you should tell your doctor if you’re breastfeeding before starting the treatment .
There are a few known interactions between trazodone and other medications that may potentially cause issues .
As always, the best way to minimize your risk is to keep your doctor up-to-date about any ongoing medications you are taking.
Some of these interactions include:
- Fluconazole (for fungal infection) can cause prednisone toxicity because both drugs are metabolized by the CYP3A4 enzyme .
- Clonidine (for blood pressure) excessively decreased blood pressure in a 12-year-old boy, which caused a syncopal episode associated with hypotension, bradycardia, and sedation .
- Warfarin (blood thinners) affected the blood clotting effect of warfarin in 3 clinically relevant cases .
Other drug interactions have also been documented. For example, consuming alcohol while on trazodone has been reported to significantly impair performance on manual (dexterity-based) tasks — significantly more than just alcohol alone — suggesting that these drugs may interact with other and potentially exaggerate their negative effects. For this reason, it is often advised that people who are currently on antidepressant medications should avoid consuming alcohol altogether .
Forms and Dosage of Trazodone
Note: the information below is presented strictly for educational purposes, and should under no circumstances be used to replace the guidance or advice of your personal doctor. Dosing any psychoactive medication is a complicated issue — and only a fully licensed medical expert is qualified to decide what the optimal dose for each patient is, based on their particular symptoms and individual medical history.
Trazodone is available in both immediate- and extended-release formulations, which typically come in doses of 50, 100, 150, or 300mg. In general, the daily dosages used for treating depression tend to be higher than those used for “off-label” uses, such as treating insomnia .
In all cases, however, the particular dosage used is something that should always be left to the discretion of the attending physician.
In most cases, doctors will advise against taking trazodone in the evening, as it can interfere with sleep onset and daytime wakefulness levels when taken too close to a person’s normal bedtime .
Trazodone for Sleep
It’s recommended with the trazodone dose for sleep that people take it at bedtime, and doses include 50, 100, 150 and 300 mg tablets. The starting trazodone dose for sleep is anywhere from 25 to 50 mg. The dose can be increased as needed. This is in comparison to the trazodone dose for sleep, which is usually anywhere from 50 to 100 mg a day, taken either at bedtime or in divided doses.
The trazodone dose for sleep usually helps people immediately, while when it’s used for depression, it can take several weeks for the full effects to be apparent.
The trazodone max dose for sleep can vary depending on the individual, but the general max dose of trazodone in a day is 300 mg. With that being said, when it comes to trazodone and insomnia, lower doses tend to be more effective, and higher doses may not be effective for insomnia or could even cause more insomnia.
So what else should you know about trazodone as a sleep aid?
First, some physicians prefer it because it is a generic drug, and is generally less expensive than many other brand names of sleep aids. Other benefits of trazodone as a sleep aid include the fact that it isn’t considered very addictive or habit-forming in most people, and it’s not a controlled substance.
While there are benefits, there are also side effects of trazodone as a sleep aid. These can include confusion, dry mouth, nervousness, blurred vision, sexual dysfunction and cardiac arrhythmia.
How does trazodone help you sleep?
Researchers aren’t exactly sure, but they believe trazodone helps you sleep by acting on certain neurotransmitters in the brain, and in particular, serotonin.
With trazodone and insomnia, it should be administered at lower doses than it would be to treat depression, for the most effectiveness. Lower doses of trazodone affect certain receptors in the brain that help induce sleep, while higher doses could have the opposite effect.
Trazodone in Veterinary Medicine
Tamara Foss CVT | ASPCA Animal Poison Control Center | Urbana, Illinois
Tamara has been with the ASPCA Animal Poison Control Center since 2000. She earned her bachelor’s degree in agriculture with an emphasis in animal health technology from Murray State University in Kentucky. Tamara especially enjoys the toxicology-, research-, and information technology–related aspects of her position at the ASPCA. She has a passion for greyhounds and is an active volunteer and foster for American Greyhound. Outside of work, she loves spending time with her greyhounds, especially helping her greyhound Callen have fun playing running games like lure coursing and straight racing.
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Toxicology Talk is written and reviewed by members of the American Society for the Prevention of Cruelty to Animals (ASPCA) Animal Poison Control Center (APCC). The mission of the APCC is to help animals exposed to potentially hazardous substances, which it does by providing 24-hour veterinary and diagnostic treatment recommendations from specially trained veterinary toxicologists. It also protects and improves animal lives by providing clinical toxicology training to veterinary toxicology residents, consulting services, and case data review.
The ASPCA APCC includes a full staff of veterinarians, including board-certified toxicologists, certified veterinary technicians, and veterinary assistants, and its state-of-the-art emergency call center routinely fields requests for help from all over the world, including South America, Europe, Asia, and the Pacific Islands.
Background of Trazodone in Veterinary Medicine
Though trazodone has generally been shown to be beneficial and relatively safe for dogs, being aware of signs associated with serotonin syndrome is important as this can be a serious and potentially life-threatening condition to manage. Treatment of trazodone overdose generally consists of symptomatic and supportive care. Trazodone is a serotonin 2A antagonist and reuptake inhibitor that has been used in human medicine as a prescription therapy for depression, aggression, sleeplessness, and anxiety since 1981.1–3 It is available in 50-, 100-, 150-, and 300-mg tablets as well as 150- and 300-mg extended-release tablets.1 No products are labeled for veterinary use.
Trazodone selectively blocks serotonin reuptake, which enhances serotonin’s effects.4 It is an antagonist of 5-HT2A, H1-histaminic, and α1-adrenergic receptors at low to moderate doses, resulting in various levels of sedation.3–6 It can have hypotensive effects.4 At higher doses, trazodone acts as a serotonin agonist, and serotonin syndrome can develop.4,6 Trazodone also has anxiolytic properties, but the exact mechanism of action is unknown.4
Use in Veterinary Medicine
In 2008, Gruen and Sherman studied 56 dogs prescribed trazodone in combination with other primary behavior therapies and discovered that trazodone seemed to offer therapeutic benefit with relatively minimal adverse effects.7 Since then, studies have investigated the benefit of trazodone in postorthopedic surgery treatment plans involving confinement to enhance calm behavior and reduce anxiety in hospitalized dogs. Trazodone has generally been shown to be beneficial and relatively safe. Adverse events associated with trazodone can be divided into behavioral and systemic signs. Adverse events previously reported in the literature include drugged or “spacy” behavior, drowsiness, panting, anxiety/restlessness/agitation, vomiting/gagging, behavioral change (counter surfing and trash raiding), excitation, sedation, increased hunger, colitis, and aggression (growling).5,7,8
In veterinary medicine, trazodone is generally dosed at 1.7 to 19.5 mg/kg/d on a daily or as-needed basis with immediate action (not extended-release) tablets and can be given with food.1 When administered in combination with tricyclic antidepressants or selective serotonin reuptake inhibitors, it is recommended to begin dosing trazodone at 2 to 5 mg/kg and increase as needed to a maximum dose of 14 mg/kg/d.1 Trazodone should be administered about an hour before potential anxiety-inducing stimuli, as its onset of action is approximately 30 to 60 minutes.1,5 Gruen and colleagues reported owner-observed duration of effect lasting 4 hours or more.5 The parent compound has an elimination half-life of approximately 7 hours in immediate-release tablets.1 Trazodone undergoes extensive metabolism in the liver and is predominantly excreted via the kidneys.1,4
Incidence and Clinical Signs
The ASPCA Animal Poison Control Center reported 417 incidences involving single-agent trazodone exposures in 379 dogs from 2009 to 2013.1 In 104 dogs experiencing adverse effects, sedation and lethargy were reported in 43% of the dogs. Ataxia was reported in 16% and vomiting in 14%. Overall, lethargy, sedation, depression, somnolence, and subdued behavior are considered common signs of trazodone exposure.9 Additional information on signs reportedly exhibited by dogs exposed to trazodone alone from January 2003 to November 2016 and the lowest dose at which each sign was seen is provided in TABLE 1.
TABLE 1 Signs Associated With Trazodone Exposure in Dogs10
|SIGN||Lowest Dose (mg/kg) at Which Sign Was Seen|
Decontamination measures are an important component of exposure management. Induction of emesis within 1 hour of exposure is recommended in asymptomatic patients if no contraindications to emesis exist.9 Activated charcoal with sorbitol may be recommended in large exposures only.9
Treatment of trazodone overdose generally consists of symptomatic and supportive care. Although adverse effects are often reported, relatively few cases have involved serious signs and no deaths are attributed to trazodone exposure to date.9 Special attention should be given to ensuring maintenance of cardiac output and being attentive to signs of hyperthermia or hypothermia and correcting as needed.9,11 IV fluid therapy may be needed to maintain blood pressure.6,9 Diazepam is the drug of choice for managing tremors or seizures, and atropine is suggested for treatment of bradycardia.6,9
Being aware of signs associated with serotonin syndrome is important as this can be a serious and potentially life-threatening condition to manage. Serotonin syndrome develops as a result of an overabundance of serotonin in the central nervous system.6 It can be a risk in cases of exposure to high doses of trazodone.1,4 Clinical signs of serotonin syndrome in dogs, in order of most to least common, include vomiting, diarrhea, seizures, hyperthermia, hyperesthesia, depression, mydriasis, vocalization, death, blindness, hypersalivation, dyspnea, ataxia/paresis, disorientation, hyperreflexia, and coma.1 Cyproheptadine, a serotonin antagonist, helps combat serotonin syndrome signs.6,11 Phenothiazines should be used cautiously because of potential hypotensive effects.6
Interaction With Other Drugs
Trazodone interacts with numerous drugs, and some of these interactions may have clinically significant effects. Of special interest are medications that may be strong inhibitors or inducers of cytochrome P450 3A4 (CYP3A4) isoenzyme, which is involved in trazodone metabolism.4 Azole antifungals (eg, ketoconazole, itraconazole, fluconazole) and macrolide antibiotics (eg, erythromycin, telithromycin, clarithromycin) are CYP3A4 inhibitors and thus may enhance the effect of trazodone.1,4 Carbamazepine, phenobarbital, phenytoin, rifampicin, and modafinil, which are CYP3A4 inducers, may decrease the effect of trazodone.1,4,9
Extreme caution should be used with concomitant trazodone and fluoxetine use and/or exposure as it is believed that fluoxetine may inhibit metabolism of trazodone.1,4 Additionally, fluoxetine and other serotonergic medications (eg, paroxetine, sertraline, amitriptyline, clomipramine, amphetamines, dextromethorphan) as well as monoamine oxidase inhibitors (eg, phenelzine, amitraz, selegiline), metoclopramide, and tramadol, could heighten the risk of serotonin syndrome when combined with trazodone.1,4,6,8
Serotonin syndrome patients with severe cardiac disease or renal and/or hepatic function deficits should be monitored very closely and may merit additional treatment measures.1
The prognosis for patients exposed to trazodone is generally good, especially when serotonin syndrome has not developed. Signs generally resolve in 12 to 24 hours.6
- Plumb DC. Trazodone HCl. In: Veterinary Drug Handbook. 8th ed. Ames: John Wiley and Sons; 2016.
- Trazodone (Poisindex Managements). In: POISINDEX® System (electronic version). Greenwood Village, CO: Truven Health Analytics. Available at: micromedexsolutions.com. Accessed December 2016.
- Gruen ME. Beyond the front line: trazodone and other ancillary treatments for anxiety. Vet Med Forum May 2012 cvm.ncsu.edu/wp-content/uploads/2015/06/Gruen_VetMedForum_May2012.pdf. Accessed December 2016.
- McEvoy GK, ed. Trazodone. In: AHFS Drug Information 2014. Bethesda, MD: American Society of Health-System Pharmacists; 2014:2450-2454.
- Gruen ME, Roe SC, Griffith E, et al. Use of trazodone to facilitate postsurgical confinement in dogs. JAVMA 2014;245:296-301.
- Wismer TA. Antidepressant drug overdoses in dogs. Vet Med 2000;95(7):520-525.
- Gruen ME, Sherman BL. Use of trazodone as an adjunctive agent in the treatment of canine anxiety disorders: 56 cases (1995-2007). JAVMA 2008;233:1902-1907.
- Gilbert-Gregory SE, Stull JW, Rice MR, et al. Effects of trazodone on behavioral signs of stress in hospitalized dogs. JAVMA 2016;249:1281-1291.
- ASPCA Animal Poison Control Center. Trazodone vet protocol. Unpublished data.
- ASPCA Animal Poison Control Center. AnTox database. Unpublished data.
- Wismer TA. Antidepressant drug overdoses. Vet Tech 2006;27(5):278-281.