Does trazodone cause extrapyramidal symptoms? (+3 factors)

In this article, we will explore whether trazodone can cause extrapyramidal symptoms. We will delve into research studies examining the association between the use of trazodone and extrapyramidal symptoms. Additionally, we will discuss the risk factors that may increase the likelihood of trazodone-induced extrapyramidal symptoms and the management of these symptoms if they occur with trazodone.

Does trazodone cause extrapyramidal symptoms?

Yes, trazodone may induce extrapyramidal symptoms (EPS). The risk of EPS, however, is notably higher in older age patients and individuals with additional risk factors.

Trazodone is commonly prescribed for the management of various mental disorders, including depression and anxiety. Additionally, it is used to address conditions like fibromyalgia and chronic pain.

While trazodone has proven effective for many individuals, it’s important to be aware of the potential side effects of this medication, including nausea, vomiting, dizziness, dry mouth, serotonin syndrome, and cardiovascular complications (1). 

What extrapyramidal symptoms are caused by trazodone?

Extrapyramidal symptoms that can be associated with the use of trazodone may include the following (2): 

• Tremors
• Rigidity
• Bradykinesia
• Akathisia
• Dystonia
• Facial Grimacing
• Hyperkinesia
• Dyskinesia
• Parkinsonism
• Tardive Dyskinesia
• Akinesia 

It is important to note that it is not necessary for individuals to experience all of these symptoms after taking trazodone. The frequency and severity of these symptoms may vary from one individual to another based on their underlying health condition and overall well-being.

What does research suggest?

According to research, the use of trazodone can lead to extrapyramidal symptoms in some individuals. However, the incidence of these side effects is low, and they rarely occur with trazodone.

In a research study, a case reported severe side effects after using trazodone for only a few days at a daily dosage of 100 mg. The symptoms reported by the patient included dystonia, restlessness, slurred speech, and tremors. The medication was discontinued, and the patient was admitted to the hospital (3). 

In another study, a patient with chronic depression started trazodone for insomnia. After taking this medication for 2 days, the patient developed extrapyramidal symptoms, including dyskinesia. The same study reported two more cases where this medication caused extrapyramidal symptoms.

In one case, the symptoms were reported after 2 weeks of treatment at a dosage of 50 mg, while the other reported these symptoms within a few days of treatment at a dosage of 400 mg (4).

What factors may increase the risk of trazodone-induced EPS? 

While trazodone-induced extrapyramidal symptoms are less frequent, they may occur in the presence of several factors. These risk factors may include the following:

Individual Factors: The age and genetics of a person may play an important role in the occurrence of various side effects of trazodone. Elderly patients are susceptible to extrapyramidal symptoms caused by trazodone compared to younger adults. Genetic predisposition may also influence the risk of trazodone-induced extrapyramidal symptoms

Medical Conditions: The risk of experiencing extrapyramidal symptoms with trazodone increases in the presence of certain medical conditions such as Parkinson’s disease, encephalitis, psychotic disorders, or a history of brain injury. The administration of trazodone in these patients should be done cautiously to avoid unwanted side effects.

Concurrent Medications: The concurrent use of trazodone with other medications, which are also associated with causing extrapyramidal side effects, such as antipsychotic medications, increases the risk of experiencing these side effects.

How to manage trazodone-induced extrapyramidal symptoms? 

The management of extrapyramidal symptoms induced by trazodone involves symptomatic treatment by specific medications aimed at alleviating these side effects.

• Anticholinergic drugs, such as benztropine, may be prescribed to counteract altered dopamine levels and mitigate symptoms like tremors and muscle rigidity.

• Adjusting the trazodone dosage or switching to alternative medications with a lower risk of extrapyramidal symptoms such as zolpidem, pregabalin, or milnacipran may be considered under healthcare professional guidance.

• Along with medication changes, your healthcare provider may suggest exercises to enhance muscle strength and flexibility.

• Lifestyle modifications, aimed at avoiding triggers and managing stress, may also be recommended to prevent the exacerbation of extrapyramidal symptoms. 

In my opinion, managing extrapyramidal symptoms induced by trazodone involves careful evaluation of risk factors, including age, genetics, and concurrent medications. Collaborative efforts between patients and healthcare providers, considering alternatives are vital for a comprehensive approach to alleviating these symptoms.

References