Dosage Forms. Tablet: 50 mg, 100 mg, 150 mg, 300 mg; Tablet, Extended Release: 150 mg, 300 mg
Common FDA Label Indication, Dosing, and Titration.
1. Depression: Immediate release, 150 mg po daily in divided doses; may titrate to 400 mg/d; Extended release, 150 mg po daily hs; may titrate to 375 mg/d
1. Insomnia: Adults: 50 po daily hs
MOA. The mechanism of antidepressant action is not fully understood, but suspected to be related to its potentiation of serotonergic activity in the CNS.
Drug Characteristics: Trazodone
Medication Safety Issues: Trazodone
Drug Interactions: Trazodone
Adverse Reactions: Trazodone
Efficacy Monitoring Parameters. Improvement in depressive symptoms (depressed mood, suicidal thoughts or intent, change in appetite, lack of energy, change in sleep patterns, lack of pleasure/interest in usual activities, feeling of excessive guilt/worthlessness, psychomotor retardation or agitation, difficulties in thinking/concentration/memory).
Toxicity Monitoring Parameters. Worsening of depression, suicidality, or unusual changes in behavior, especially at the initiation of therapy or with dosage increases or decreases. Irregular heart rate in patients with cardiac disease and/or risk factors associated with QT prolongation. Signs/symptoms of peripheral edema, increased heart rate, signs/symptoms of liver damage. Monitor ECG, LFT, SCr, BUN, and vital signs.
Key Patient Counseling Points. Extended-release tablet may be broken in half, but do not chew or crush. Extended-release tablets should be taken on an empty stomach, but the immediate-release tablets should be taken with food. Patients should avoid driving and other activities requiring mental alertness or coordination until drug effects are realized, as this medicine may cause dizziness or somnolence. Report signs/symptoms of priapism immediately. Report use of MAOI within the past 14 d. Advise patients against sudden discontinuation of drug. Do not drink alcohol, or use barbiturates or other CNS depressants while taking this drug.
Clinical Pearls. Antidepressants increased the risk of suicidal thinking and behavior in children, adolescents, and young adults in short-term studies with major depressive disorder (MDD) and other psychiatric disorders. This risk must be balanced with the clinical need. Monitor patients closely for clinical worsening, suicidality, or unusual changes in behavior.