Does trazodone cause bruising? (3+ factors)

In this article, we will discuss whether trazodone causes bruising. We will also discuss the mechanism of trazodone-associated bruising and factors that increase the risk of bruising while taking trazodone and share evidence from literature and other relevant information. 

Does trazodone cause bruising?

Yes, trazodone can cause bruising in some individuals. Although the incidence of bruising while taking trazodone is rare, an increased risk of bruising and bleeding is associated with trazodone-like antidepressants. 

Trazodone belongs to the class of antidepressants called serotonin antagonists and reuptake inhibitors (SARIs). It is primarily used for major depressive disorder (MDD). It is also used as a hypnotic due to its sedative properties (1).

Antidepressants like trazodone that block the reuptake of serotonin, are associated with increased risk of bleeding (2). Bruising occurs when capillaries closer to the skin break and blood is leaked into the nearby tissues. 

When an individual is at increased risk of bleeding, it means that their clotting mechanisms are compromised. Thus, their ability to bruise even with minor traumas is increased and they present with large and frequent bruises. 

Thus, individuals at higher risk of bleeding are easy to bruise. Antidepressants that increase the risk of bleeding also elevate the risk of bruising in individuals. Trazodone is included in the category of such antidepressants. 

How does trazodone cause bruising?

Trazodone’s mechanism of action is multifaceted. It blocks the reuptake of serotonin and increases serotonin levels in the body. It also acts as an antagonist of some serotonin receptors including 5-HT2A and 5-HT2C (1). 

Trazodone also blocks histamine (H1) and alpha-1 adrenergic receptors. The increased risk of bleeding associated with trazodone is due to its effect on serotonin receptors (1). 

Antidepressants that block serotonin reuptake, also block the transporter required to carry serotonin in the platelets. This decreases serotonin levels in the platelet (3). Serotonin in the platelets is needed for hemostasis and platelet aggregation (2). 

Thus, by blocking serotonin reuptake, trazodone increases the risk of bleeding in individuals. It also blocks 5HT2 receptors which are involved in the regulation of platelet aggregation initiated by serotonin (2). 

What does research suggest?

The incidence of bruising caused by trazodone is not frequently reported in the literature. However, the increased risk of bleeding is associated with trazodone and is often mentioned in the literature. 

The guidelines issued by manufacturers of trazodone tablets have mentioned that due to the association of drugs that block serotonin reuptake with increased risk of bleeding, trazodone should be used cautiously with drugs that affect clotting (4). 

Studies have shown that the serotonin reuptake inhibition activity of trazodone is weak. Despite the weak activity, trazodone has the greatest risk of gastrointestinal (GI) bleeding. This risk is due to its antagonist effect on 5HT2 receptors (2).

One study evaluated the risk of bleeding associated with antidepressants. The results revealed that trazodone was associated with a minimal risk of bleeding in patients with post-stroke depression (5). 

What are the risk factors for bruising while taking trazodone? 

The risk of bruising and bleeding while taking trazodone is higher when individuals are already susceptible to bruising. This is due to the presence of some risk factors including health conditions, use of some medications, age, and trazodone dosage.

Health conditions: 

Pre-existing bleeding disorders and deficiency of some clotting factors increase the risk of bleeding and bruising. This risk is elevated when individuals use trazodone. Some examples of such health conditions include (6):

• hemophilia
• thrombocytopenia
• von Willebrand disease
• inherited platelet disorders
• inherited coagulation disorders

Concurrent medications: 

Concomitant use of trazodone with medications that interfere with the clotting ability of blood increases the risk of bleeding.

Thus, medications like NSAIDs, aspirin, warfarin, and drugs with antiplatelet and anticoagulant activity should be used cautiously with trazodone. 

Age:

With passing age our skin becomes thinner and collagen production decreases so the skin is not able to effectively protect the blood vessels from injury. Thus, older adults using trazodone have a higher risk of bleeding and bruising. 

High dosage:

Trazodone is used in low doses of 25-100mg for its sedative properties. At these doses, it does not saturate serotonin transporters. Individuals needing trazodone for its antidepressant activity are prescribed higher doses of 150-600 mg (7).

Thus, patients taking higher doses of trazodone can be at higher risk of bruising due to its impact on serotonin receptors. 

What to do if trazodone causes bruising?

You must contact your healthcare provider if you observe the following warning signs: 

• If you observe bruises without recalling any reason like a trauma or injury
• If the bruises are large, frequent, and increase in size quickly
• If you observe other symptoms along with bruises like fever, nausea, bleeding from gums, fatigue, and prolonged bleeding from wounds

Your healthcare provider may consider dose reduction or switch to an alternate drug if you experience unusual bruising while taking trazodone. 

Tips to avoid bruising while taking trazodone: 

You can use the following tips to avoid and manage bruising while taking trazodone:

• Be cautious to avoid injuries. Use protective gear while doing activities that can cause injury. Ensure that you have good lighting at home and that furniture is placed appropriately so the chances of bumping are minimized.
• Ensure that you consume a nutrient and mineral-rich diet. Vitamin K and vitamin C are some nutrients that reduce the risk of bleeding and bruising
• You can use cold packs to reduce the pain and inflammation of your bruises.
• Topical products with arnica can also be used to reduce bruising

What are some other side effects of trazodone?

Some common side effects of trazodone include (1):

• drowsiness
• headache
• fatigue
• dizziness
• QT prolongation
• dry mouth
• acid reflux

In my perspective, trazodone can cause bruising in some individuals although it is a rarely reported side effect. The increased risk of bleeding is due to the effect of trazodone on serotonin receptors.

Antidepressants like trazodone are associated with an increased risk of bruising therefore caution is also required while using trazodone. Research suggests that trazodone is associated with a high risk of gastrointestinal bleeding. 

Individuals with bleeding disorders, older adults, and those taking higher doses of trazodone are at higher risk of bruising.

Concomitant use of trazodone with medications like NSAIDs and drugs with antiplatelet and anticoagulant activity should be used cautiously. 

If you experience the warning signs of bruising, you must contact your healthcare provider. You can take preventive measures to reduce the risk of bruising while taking trazodone. 

References