Can Trazodone and Lexapro be taken together? (3+ precaution)

This article will discuss whether Trazodone and Lexapro can be taken together. We will also discuss the research studies associated with the use of this combination. We will also talk about the side effects associated with Trazodone and Lexapro are taken together.

Can Trazodone and Lexapro be taken together? 

Yes, Trazodone can be taken with Lexapro. Trazadone is used to manage insomnia in patients taking selective serotonin reuptake inhibitors (SSRIs), which can cause insomnia in some individuals and also in patients who have depression and experience insomnia. (1)

Lexapro (escitalopram) is an SSRI which can help treat symptoms of depression and anxiety disorders. Trazodone is an antidepressant of class serotonin-antagonist and reuptake inhibitors, which is approved to treat depression, sleep disorders, anxiety, fibromyalgia, etc. (2, 3)

Trazodone can cause sedation, which helps manage insomnia and depression. It is usually given in a low dose when combined with an SSRI. When Trazodone is combined with other antidepressants, it can increase the risk of serotonin syndrome. 

If you notice any unwanted changes in your body or behaviour, make sure you consult your physician. Do not stop taking the medication, as it can cause withdrawal symptoms. 

What does research suggest? 

Research studies have suggested that a combination of antidepressants can provide enhanced efficacy and is more commonly used to deal with the side effects associated with antidepressant therapy such as Trazodone is used to treat insomnia in patients treated with an SSRI class of antidepressants, and Bupropion is added to SSRI or SNRI regimen to deal with sexual dysfunction. (4)

A case study by Filiz Izci et al. showed that a 72-year-old female patient who was diagnosed with an anxiety disorder was being treated with 10mg of escitalopram and 50mg of Trazodone. After one week of Trazadone therapy, she developed symptoms of mania, irritability and insomnia, following which Trazodone was discontinued, and she was treated with other antidepressants. (5)

Another case study reported the beneficial effect of Trazodone in treating nocturnal bruxism associated with escitalopram treatment. A 34-year-old diagnosed with bipolar 2 disorder was being treated with escitalopram 20mg, clonazepam 2.5mg, and carbamazepine 800mg. He complained of orofacial pain along with grinding and clenching during sleep, which were the symptoms of nocturnal bruxism. He was then treated with 200mg of Trazodone, following which his symptoms resolved within 10 days. (6)

It was concluded that escitalopram caused nocturnal bruxism, leading to the discontinuation of the drug. Zopiclone 7.5 mg was added, and the dose of Trazodone was reduced to 150mg. (6)

What are the side effects of taking Trazadone and Lexapro together? 

Taking Trazodone with Lexapro can cause some side effects. Research studies have shown that this combination can cause mania. (5)

Escitalopram and Trazodone act on serotonin receptors, which fluctuate the level of serotonin, leading to serotonin syndrome. However, the side effects caused by drugs are highly variable, and not all individuals experience it.

Side effects caused by Trazodone

• Headaches
• Fatigue
• Dizziness
• Drowsiness
• Dry mouth
• Orthostatic hypertension
• QT prolongation
• Increased suicidal thoughts

Side effects of Escitalopram (Lexapro) include: 

• Insomnia
• Sexual dysfunction 
• Nausea
• Increased sweating
• Fatigue
• Drowsiness
• Serotonin Syndrome
• Hyponatremia 

If you are experiencing any unwanted side effects after taking these drugs, consult your physician immediately for proper management. 

What are the alternatives to the Trazadone and Lexapro combination? 

If you are experiencing side effects or do not respond to the drug, you can choose to switch to other antidepressants such as: 

• SSRIs: citalopram, fluoxetine, paroxetine, sertraline.
• SNRIs: venlafaxine, milnacipran, desvenlafaxine, levomilnacipran.
• Tricyclic antidepressants: amitriptyline, amoxapine, nortriptyline, imipramine. 
• Atypical antidepressants: Bupropion, mirtazapine
• Monoamine oxidase inhibitors (MAOIs): isocarboxazid, selegiline.

Other antidepressants which can help treat insomnia include antidepressants (mirtazapine, amitriptyline, doxepin), benzodiazepines (triazolam, estazolam, temazepam, quazepam, flurazepam), melatonin agonist (ramelteon), Orexin receptor antagonist (suvorexant), atypical antipsychotics (quetiapine, olanzapine, risperidone), antihistamines (diphenhydramine, doxylamine) herbal supplements (valerian, Kava). (7) 

Any adjustment to your treatment regimen should be made under the guidance of a qualified physician. If you experience any side effects, make sure to consult your physician to evaluate and adjust your treatment plan as needed.

What are the measures to use Trazadone and Lexapro effectively? 

There are a few measures you can follow while using Trazodone and Lexapro to ensure its safe and effective use, such as: 

• Take the drug as prescribed by your doctor; you can take Lexapro in the morning if it is causing insomnia and Trazodone at night. 
• Do not miss the dose of the drug, as it can cause withdrawal symptoms. 
• If you tend to forget to take your dose, set up an alarm which will remind you to take your meds. 
• Do not stop taking the medication if you are experiencing any unwanted side effects.
• Abrupt discontinuation of the drug can cause withdrawal symptoms and worsen your condition. 
• If you are experiencing any side effects, make sure you consult your physician for proper management. 
• Consult your physician before taking any OTC medication since some drugs can interact with the current medication and increase the risk of side effects. 
• You can consider other non-pharmacological therapies, like cognitive behavioural therapy, psychotherapy, etc, to help you manage your mental illness. 

In my opinion, as a pharmacist, you can take Lexapro and Trazodone together. This combination is usually prescribed to treat insomnia associated with antidepressants such as Lexapro. This combination can cause side effects in some individuals. I recommend you monitor for any unwanted side effects and report them to your physician. 

References