Does trazodone cause orthostatic hypotension?(+5 factors)

In this article, we will discuss whether trazodone can cause orthostatic hypotension. We will discuss research studies regarding trazodone and orthostatic hypotension. We will also discover some factors that may cause orthostatic hypotension due to trazodone.

Does trazodone cause orthostatic hypotension?

Trazodone may cause orthostatic hypotension. Trazodone is not commonly associated with causing orthostatic hypotension, however, due to individual patient variation, some patients may develop orthostatic hypotension due to trazodone. 

Trazodone belongs to serotonin antagonist and reuptake inhibitor drug class of antidepressant medications. Trazodone exerts its action by serotonin modulation in the brain (1).

Trazodone is an FDA-approved drug for the treatment of major depressive disorder. It is also used off-label for the treatment of anxiety, insomnia, fibromyalgia, bulimia, substance abuse, and Alzheimer’s disease (1). 

Orthostatic hypotension is a sudden drop in blood pressure upon standing. It increases the risk of falls, cardiovascular diseases, dementia, depression, and death. It also affects the quality of life of individuals. The rate of morbidity and mortality is high due to orthostatic hypotension (2). 

While trazodone is generally considered a safe antidepressant that does not mess you up, it may still cause a few side effects including orthostatic hypotension in a few patients. You must reach out to your doctor if you experience severe side effects after initiating trazodone treatment. 

What does research suggest?

According to research studies, trazodone has the potential to induce orthostatic hypotension in susceptible patients. Orthostatic hypotension is reported in about 1-7% of patients taking trazodone (3).

Trazodone works by altering the neurotransmitter levels of serotonin, histamine,    and norepinephrine. Due to the inhibition of alpha-1 adrenoceptors in the brain, a sudden drop in blood pressure resulting in orthostatic hypotension may occur (3). 

However, trazodone-induced orthostatic hypotension is most commonly associated with geriatric patients. Another group of patients taking trazodone who are susceptible to orthostatic hypotension are those with underlying cardiac health conditions (3). 

What factors influence trazodone-induced orthostatic hypotension?

The following few factors may influence trazodone-induced orthostatic hypotension in patients:

• Dosage- Taking trazodone at higher doses is more commonly associated with causing side effects such as orthostatic hypotension. Trazodonemust be taken at the lowest effective therapeutic dose to avoid orthostatic hypotension. 

• Individual patient variation- Individual patient variation to trazodone may vary from patient to patient. Factors such as age, overall health, and response to trazodone may vary among patients. 

• Medical conditions- Patients with underlying cardiovascular health conditions, dehydration, autoimmune disorders, and nervous system disorders are more prone to develop orthostatic hypotension. 

• Concurrent medications- Patients taking concomitant medications along with trazodone may increase the risk of interactions. Taking medications that particularly affect cardiovascular health may develop orthostatic hypotension. 

• Postural changes- The sudden change in postural position can cause orthostatic hypotension in patients. Patients must be advised to slowly change their position to minimize the risks. 

What are the symptoms of orthostatic hypotension?

The following symptoms may commonly represent orthostatic hypotension (2):

• Lightheadedness
• Dizziness
• Loss of consciousness
• Sudden falls

Some less commonly associated symptoms of trazodone include:

• Blurry vision
• Difficulty in concentration
• Weakness
• Fatigue
• Shortness of breath
• Chest pain
• Backache

However, it is important to note that not all patients suffering from orthostatic hypotension suffer from these symptoms. Some patients with orthostatic hypotension may be severely affected while others may not face these symptoms severely. 

What to do if trazodone causes orthostatic hypotension?

After starting your treatment with trazodone, if you suffer from symptoms of orthostatic hypotension such as lightheadedness and dizziness, then you must seek medical help. 

Your healthcare provider must check your blood pressure and identify risk factors that may cause orthostatic hypotension. If the orthostatic hypotension is due to trazodone, then your doctor must lower or adjust the dose of trazodone. 

If some other factors are associated with orthostatic hypotension, such as other medication or any health condition, then those factors must be removed to get rid of orthostatic hypotension. 

Non-pharmacological treatments for orthostatic hypotension such as well hydration, increased salt intake, gradual and continuous postural changes, and lifestyle modifications may help in improving orthostatic hypotension. 

However, some medical interventions such as fludrocortisone and midodrine which are the first-line medications for orthostatic hypotension may be started under your doctor’s guidance and supervision (2). 

However, if it is discovered that trazodone is causing orthostatic hypotension, it must be discontinued. Then your doctor must lower the dosage before discontinuing trazodone to avoid withdrawal symptoms. 

In my opinion as a pharmacist, you must monitor your symptoms after initiating trazodone treatment. If it causes symptoms of orthostatic hypotension, then seek medical help. 

However, considering pharmacological treatment solely for orthostatic hypotension must be done with a complete evaluation of benefits over risks. If the benefits outweigh the risks then the treatment must be continued under your doctor’s supervision. 

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