Does trazodone increase bleeding risk? (3+ cautions)
By
Ivan Kahwa
Author bio
Mr Ivan Kahwa is a chemist and phytopharmaceutical scientist with expertise in chemistry, pharmacology, phytochemistry, and Nanobiotechnology. He writes and reviews content on these topics.
Mr Ivan Kahwa’s Highlights:
Guest Researcher at the University of Leipzig, Senior Research Fellow/Scientist, and Lecturer at the Department of Pharmacy, Faculty of Medicine, Mbarara University of Science and Technology.
Professional Experience:
Mr Ivan joined PHARMBIOTRAC as a research fellow/scientist during his master of science tenure. He contributed to the development of most of the phytopharmaceutical products in the project. Furthermore, he participated in carrying out the pharmacological activities of the developed products in laboratory animals such as mice and rats in order to develop proper doses hence leading to pre-clinical studies.
With the above relevant research experience, Ivan started to work with the University of Leipzig on collaborative projects with Mbarara University to develop the chemistry of Ugandan Medicinal plants and their pharmacological activities. This was coupled with several consultative positions by different German NGOs. Mr. Kahwa is also a supporting in the teaching and learning at the Departments of Pharmacy and Pharmaceutical Sciences, Faculty of Medicine, Mbarara University of Science and Technology.
With the increase in antimicrobial resistance globally, Ivan retooled his thinking towards developing new naturally derived antibiotic regimens from Ugandan propolis with the assistance of nanotechnology to improve their delivery to microbial cells. Kahwa has also published over 28 articles in peer-reviewed journals and he is currently reviewing for many journals.
Education:
2023-2027: PhD in Pharmaceutical Sciences (ongoing) with a focus on Pharmaceutical Microbiology and Nanobiology at Mbarara University of Science and Technology.
2022: 2Msc. in Pharmacognosy and Natural Medicine Science at Mbarara University of Science and Technology.
2018: Bachelor of Science (Chemistry) at Mbarara University of Science and Technology.
Publications:
▪ Iqbal, S., Jabeen, F., Kahwa, I., & Omara, T. 2023. Suberosin Alleviates Thiazolidinedione-Induced Cardiomyopathy in Diabetic Rats by Inhibiting Ferroptosis via Modulation of ACSL4-LPCAT3 and PI3K-AKT Signaling Pathways. Cardiovascular Toxicology. https://doi.org/10.1007/s12012-023-09804-7
▪ Gupta, A. K., Yadav, R., Sharma, S., Sawale, J., & Kahwa, I. 2023. Anti-ageing Activity and Antioxidant Activity of Methanol Extracts of Leaves and Flowers of Salvia officinalis and Rosmarinus officinalis. Journal of Young Pharmacists, 15(3), 448–455. https://doi.org/10.5530/jyp.2023.15.60
▪ Tolo, C.U., Kahwa, I., Nuwagira, U., Weisheit, A. and Ikiriza, H., 2023. Medicinal plants used in treatment of various diseases in the Rwenzori Region, Western Uganda. Ethnobotany Research and Applications, 25, pp.1-16.
https://ethnobotanyjournal.org/index.php/era/article/view/4683
▪ Kahwa, I., Ajayi, C.O., Yadav, R., Chauhan, N.S., Shah, K., Abdelgadir, A.A., Shegena, E.A., Daniel, S., Omara, T., Asiimwe, J.B. and Ikiriza, H., 2023. Pharmacognostic and phytochemical studies as an invaluable approach for correct identification of medicinal plants: The case of Artemisia vulgaris L. substituted for Artemisia annua L. in Western Uganda. TMR Integr Med, 7, p.e23004.
https://doi.org/10.53388/TMRIM202307004
▪ Nalimu, F., Oloro, J., Kahwa, I. and Ogwang, P.E., 2021. Review on the phytochemistry and toxicological profiles of Aloe vera and Aloe ferox. Future Journal of Pharmaceutical Sciences, 7, pp.1-21.
https://doi.org/10.1186/s43094-021-00296-2
▪ Elamin, O.H.S., Ali, M.A., Elgezuli, I.A.A., Bashir, M.A. and Kahwa, I., 2021. Diagnosis of pre-and post-treatment of echinococcus granulosus with counter current immune electrophoresis and bacterial co-agglutination. Journal of Microbiology and Infectious Diseases, 11(02), pp.88-94.
https://doi.org/10.5799/jmid.951600
Published book Chapter
▪ Kahwa, I., Ayesiga, I., Nakalema, S., Alinaiswe, R., Mbabazi, R. and Iqbal, S., 2023. Natural products in the management of onchocerciasis. In Natural Products in Vector-Borne Disease Management (pp. 63-80). Academic Press. Book Chapter.
https://doi.org/10.1016/B978-0-323-91942-5.00012-4
Submitted manuscripts Under Review:
▪ Comparison of the Wound Healing Activity of the Leaf and Leaf Ash Extracts of Vernonia amygdalina in Rats. Journal name: Clinical Phytoscience
▪ Ethnobotanical Survey of Medicinal plants used in the management of cancer in Uganda. Journal name: Journal of Herbal Medicine
▪ Ethnobotanical survey and phytochemical screening of medicinal plants used in treatment of epilepsy by PROMETRA-Uganda Traditional Health Practitioners in Mpigi District, Uganda. Journal name: Journal of Ethnopharmacology
Submitted book chapters under review
1.Book title: Algae as a Natural Solution for Water-Food-Energy Nexus, Section 4: Microalgae and cyanobacteria for food applications, Chapter 4.6: Safety, toxicological and allergenic aspects of using algae for food. Authors: Christine Kyarimpa, Tom Omute, Caroline K. Nakiguli, Alice V. Khanakwa4, Christopher Angiro, Ivan Kahwa, Fortunate Ahumuza, Timothy Omara*. Publisher: Springer Nature Singapore Pte Ltd. 152 Beach Road, #21-01/04 Gateway East, Singapore 189721, Singapore.
2.Book title: Nutraceuticals Inspiring the Contemporary Therapy for Lifestyle Diseases. Chapter: Nutraceutical applications of Seaweeds and their Phytocompounds in Nutrition and Treatment of Diseases. Authors: Ivan Kahwa, Timothy Omara , Innocent Ayesiga , Gael Noel Neh Neba Ambe , Zehbanaz Javidbhai Panwala , Rachel Mbabazi , Shabnoor Iqbal , Christine Kyarimpa , Christine Betty Nagawa , Kamal Shah ,Nagendra Singh Chauhan* Publisher: CRC Press
You can view my works on the following professional sites:
Research Gate: https://www.researchgate.net/profile/Ivan-Kahwa
Google Scholar: https://scholar.google.com/citations?user=tOwrvqoAAAAJ&hl=en
ORCID: https://orcid.org/0000-0002-6440-3437
Linkedin: https://de.linkedin.com/in/ivan-kahwa-865450159
In this article, we will discuss whether trazodone can increase the risk of bleeding, what research suggests, what factors can contribute to trazodone-induced bleeding risk, and what to do if you are concerned about increased bleeding with trazodone use.
Does trazodone increase bleeding risk?
Yes, trazodone can increase the risk of bleeding in individuals using it for the treatment of depressive disorders. Trazodone is generally considered safe for use, but it has a tendency to increase the risk of bleeding, especially when used in combination with drugs that affect blood clotting. (1)
Trazodone belongs to the class of drugs known as serotonin modulators, which affect the balance of serotonin in the brain. It is an FDA-approved drug for the treatment of major depressive disorders, but it can also be used to treat sleep problems. (2)
However, individual responses to trazodone can differ, and not everyone will experience an increased risk of bleeding.
How does trazodone increase the risk of bleeding?
Trazodone’s tendency to increase bleeding risk is believed to be related to an increase in serotonin levels in the synaptic cleft of the brain. Trazodone increases serotonin levels by inhibiting serotonin transporter and serotonin type-2 receptors and interferes with platelet function and coagulation pathway.
The risk of bleeding increases with the concomitant use of NSAIDs, warfarin, and other anticoagulant drugs. (2)
What does research suggest?
Research on the bleeding risk with the use of trazodone, a serotonergic antidepressant, suggests that trazodone is among those antidepressants that have the highest risk of gastrointestinal bleeding, and with the concomitant use of NSAIDs, this risk increases by many folds. (3)
Another study was done on orthopaedic patients who had hip replacement surgery; 66 patients used serotonergic antidepressants, 29 patients used nonserotonergic antidepressants, and 285 patients were in the reference group. The study concludes that the group of patients on serotonergic antidepressants had significantly higher blood loss during the procedure. (4)
A nonsystemic review of the bleeding risk with antidepressants concluded that the drugs with the serotonin inhibition mechanism increase the bleeding risk by 1.16- to 2.36-fold, and by using the NSAIDs with these drugs, this risk increases by 3.17-10.9-fold. (5)
Another study suggested that the combination of NSAIDs and trazodone can cause intracranial hemorrhage (ICH). Trazodone alone can also cause ICH in patients using it to treat their mental health conditions. (6)
What factors can contribute to increased bleeding risk with trazodone?
Several factors may contribute to the risk of bleeding in individuals using trazodone to treat their mental health conditions. These include:
- Drug interaction: Trazodone may interact with other medications and increase the risk of bleeding. These drugs are nonsteroidal anti-inflammatory drugs (NSAIDs), anticoagulants, warfarin, and other antiplatelet drugs. (1)
- Age: Age can factor into increasing the bleeding risk with trazodone. Geriatrics are more susceptible to bleeding with the use of trazodone. (7)
- Underlying health conditions: Patients with underlying conditions, such as bleeding disorders, liver disease, and stomach ulcers, may be more susceptible to the risk of bleeding with trazodone use.
- Individual variability: Individual responses to trazodone can differ. Genetic and metabolic variabilities can also play a role and increase bleeding risk in people using trazodone.
- Dosage and duration of use: Higher doses of trazodone and long-term use may contribute to an elevated risk of bleeding. It is crucial for healthcare providers to assess the appropriate dosage for each patient and carefully monitor them to avoid any unwanted symptoms.
What to do if bleeding risk with trazodone concerns you?
If you are using trazodone and are concerned about the potential risk of bleeding, it is crucial to discuss your concerns with your healthcare provider. Inform your doctor about all the medications, supplements, or OTC drugs to avoid potential interactions that may cause an emergency situation.
Your doctor can consider these options:
- Lower your dosage: Your doctor might consider lowering the dose, as high doses can increase the risk of bleeding.
- Treat underlying conditions: Your healthcare provider might advise you to get treatment for underlying health conditions that may increase the risk of bleeding.
- Switch to an alternative: Your doctor might consider switching you to other antidepressants that have a different side effect profile than trazodone. e.g., agomelatine, bupropion, mirtazapine, etc.
- Close monitoring: Your doctor will closely monitor you for signs of bleeding if you are in a high-risk group.
Your doctor will provide you with guidance according to your needs to make treatment more comfortable for you.
According to my knowledge and research on the topic, trazodone can increase bleeding risk in patients using it for major depressive disorders and insomnia. It is crucial for individuals using this medication to be on the lookout for any concerning signs and communicate openly with their healthcare providers.
Understanding the potential risk factors and taking precautions can help ensure the safe and effective use of trazodone in the management of depression and anxiety disorders.
Was this helpful?
References
1.-
Trazodone, a prescribing guide by The U.S. Food and Drug Administration, Available from: https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/018207s032lbl.pdf
2.-
Shin JJ, Saadabadi A. Trazodone. [Updated 2022 Jul 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470560/
3.-
Wan Po, A. L. (1999). Antidepressants and upper gastrointestinal bleeding: New results suggest a link. BMJ : British Medical Journal, 319(7217), 1081-1082. https://doi.org/10.1136/bmj.319.7217.1081
4.-
Van Haelst IM, Egberts TC, Doodeman HJ, Traast HS, Burger BJ, Kalkman CJ, Van Klei WA. Use of serotonergic antidepressants and bleeding risk in orthopedic patients. The Journal of the American Society of Anesthesiologists. 2010 Mar 1;112(3):631-6. https://doi.org/10.1097/ALN.0b013e3181cf8fdf
5.-
Bixby, A. L., VandenBerg, A., & Bostwick, J. R. (2018). Clinical Management of Bleeding Risk With Antidepressants. Annals of Pharmacotherapy. https://doi.org/10.1177/1060028018794005
6.-
Hou, C., Lin, J., Lin, Y., Hwang, J., & Wang, C. (2020). Risk of Intracranial Hemorrhage With Concomitant Use of Antidepressants and Nonsteroidal Anti-inflammatory Drugs: A Nested Case-Control Study. Annals of Pharmacotherapy. https://doi.org/10.1177/1060028020980417
7.-
Wysokiński Adam, Margulska Aleksandra and Sobów Tomasz, Bleeding Complications in the Course of Treatment with Antidepressants in Elderly Patients, Current Psychiatry Reviews 2015; 11 (4) . https://dx.doi.org/10.2174/1573400512666151125222237
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