Does Trazodone need to be tapered before discontinuation?
By
Dr Milena Locci de Oliveira (PhD)
Author bio
Dr Milena Locci de Oliveira is a Pharmacist and Doctor of Philosophy in Sciences from the University of São Paulo (USP). She has experience in microbiology, analytical toxicology, and clinical pharmacokinetics. She writes and reviews content on these topics.
Dr Milena’s Highlights:
-PhD in Sciences, University of São Paulo, Brazil, 2019.
-University College London (UCL) – Semester of remote collaboration in the areas of Pharmacometrics and Population Pharmacokinetics, 2018.
-Bachelor in Biochemical Pharmacy, University of São Paulo, Brazil, 2013.
“Science can be translated, and it is essential that everyone has access to quality information to make informed decisions” – Dr Milena Oliveira, PhD.
Professional Experience:
With a decade-long career as a researcher, Dr Milena has amassed extensive experience in conducting research projects in microbiology, analytical toxicology, and clinical pharmacokinetics.
Her expertise also extends to the preparation of technical and scientific reports, literature reviews, data analysis, and scientific communication, both oral and written.
Dr Milena has served as a Clinical Pharmacist, providing expert supervision and guidance to teams during the challenging times of the COVID-19 pandemic, particularly in the ICUs of two reference hospitals for patient hospitalization.
In her most recent role, Dr Milena worked on the implementation of the deliberatives of the São Paulo State Government Pharmaceutical Assistance Coordination. These decisions were aimed at ensuring medication access within the Unified Health System.
A widely multidisciplinary background enabled Dr Milena to become a professional capable of integrating scientific knowledge into private initiatives, education, and healthcare, delivering consistent services in patient safety and population health.
Professional Memberships & Affiliations:
Dr Milena Oliveira is a member of the Regional Council of Pharmacy of the State of São Paulo, Brazil.
Education:
-PhD in Sciences, University of São Paulo, Brazil, 2019.
-University College London (UCL) – Semester of remote collaboration, 2018.
-Bachelor in Biochemical Pharmacy, University of São Paulo, Brazil, 2013.
Relevant Published Work & Citations:
Oliveira ML de, Rocha A, Nardotto GHB, Pippa LF, Simões BP, Lanchote VL. Analysis of daunorubicin and its metabolite daunorubicinol in plasma and urine with application in the evaluation of total, renal and metabolic formation clearances in patients with acute myeloid leukemia. Journal of Pharmaceutical and Biomedical Analysis. Nov 2020. 191:113-124.
Abstracts. CPT: Pharmacometrics & Systems Pharmacology. 2020 Nov; 9 (S1).
Pippa LF, Oliveira ML de, Rocha A, de Andrade JM, Lanchote VL. Total, renal and hepatic clearances of doxorubicin and formation clearance of doxorubicinol in patients with breast cancer: Estimation of doxorubicin hepatic extraction ratio. Journal of Pharmaceutical and Biomedical Analysis. 2020 Jun 5; 185:113-231.
Godoy ALPC, De Jesus C, De Oliveira ML, Rocha A, Pereira MPM, Larangeira DF, Lanchote VL, Barrouin-Melo SM. Determination of Allopurinol and Oxypurinol in Dogs Plasma by High-Performance Liquid Chromatography with an Ultraviolet Detector: Application for Pharmacokinetic Studies. J Chromatogr Sep Tech. 2017; 8 (4).
Clímaco EC, Oliveira ML de, Pitondo-Silva A, Oliveira MG, Medeiros M, Lincopan N, et al. Clonal complexes 104, 109 and 113 playing a major role in the dissemination of OXA-carbapenemase-producing Acinetobacter baumannii in Southeast Brazil. Infection, Genetics and Evolution. 2013 Oct;19:127–33.
Conference Papers:
Oliveira, M. L.; NARDOTTO, G. H. B.; PIPPA, L. F.; ROCHA, A.; SIMOES, B. P.; LANCHOTE, V. L. . Daunorubicin metabolism and urinary excretion in patients with acute myeloid leukemia. In: 84th Annual Meeting of the German Society for Experimental and Clinical Pharmacology and Toxicology (DGPT) and the 20th Annual Meeting of the Association of the Clinical Pharmacology Germany (VKliPha), 2018, Göttingen. Naunyn-Schmiedeberg’s Arch Pharmacol, 2018. v. 391. p. S76-S76.
Oliveira, M. L.; NARDOTTO, G. H. B. ; ROCHA, A. ; SIMOES, B. P. ; LANCHOTE, V. L. . The low contribution of urinary excretion in the elimination of daunorubicin and its metabolite daunorubicinol in patients with acute myeloid leukemia. In: 49th Brazilian Congress of Pharmacology and Experimental Therapeutics., 2017, Ribeirão Preto. Livro de Resumos, 2017. p. 64-64.
Oliveira, M. L.; PIPPA, L. F. ; ROCHA, A. ; SIMOES, B. P. ; LANCHOTE, V. L. . Quantification of daunorubicin and its metabolite daunorubicinol in human plasma by LC-MS/MS. In: I International Meeting of Environmental Health and Toxicology (IMEHTOX), 2016, Ribeirão Preto. Livro de Resumos, 2016.
Oliveira, M. L.; Clímaco, E.C. ; OLIVEIRA, M. G. ; Lincopan, N. ; Darini A.L.C. . PFGE typing of Carbapenem-Resistant Acinetobacter baumannii isolated from different University Hospitals. In: V International Postgraduate and Research Symposium, 2012.
Clímaco, E.C. ; SILVA, A. P. ; Oliveira, M. L. ; OLIVEIRA, M. G. ; Lincopan, N. ; Darini A.L.C. Relação clonal entre linhagens de Acinetobacter baumannii produtoras de carbapenemases da família OXA em quatro hospitais no Brasil. In: XXI Latin American Congress of Microbiology, 2012, Santos. XXI Latin American Congress of Microbiology, 2012.
Oliveira, M. L.; Clímaco, E.C. ; OLIVEIRA, M. G. ; Darini A.L.C. . Dissemintion of OXA carbapenemases genes in carbapenem-resistant Acinetobacter baumannii in University Hospital of Juiz de Fora, MG. In: 8th CIFARP – International Congress of Pharmaceutical Sciences, 2011, Ribeirão Preto.
Clímaco, E.C. ; Oliveira, M. L. ; OLIVEIRA, M. G. ; Darini A.L.C. . Avaliação do sequenciamento parcial do gene rpoB e de seus flanqueadores para identificação de espécies de Acinetobacter na rotina laroratorial. In: 2° International Symposium on Clinical Microbiology, 2010, Florianópolis.
You can view some of Dr Milena’s work below and links to her professional profile.
Linkedin: https://www.linkedin.com/in/dra-milena-locci-de-oliveira-28986042/?locale=en_US
ResearchGate: https://www.researchgate.net/profile/Milena-Oliveira-6
Escavador: https://www.escavador.com/sobre/5394254/milena-locci-de-oliveira
Lattes: https://buscatextual.cnpq.br/buscatextual/busca.do
Scopus: https://www.scopus.com/authid/detail.uri?authorId=57199779361
Scholar: https://scholar.google.com/citations?view_op=list_works&hl=pt-BR&user=1YUBDIQAAAAJ
Does Trazodone need to be tapered before discontinuation?
Yes, Trazodone does need to be tapered off and should not be stopped abruptly. Trazodone is an antidepressant which can be used for depression, anxiety, insomnia, and other mental health conditions.
This medication is prescribed at both high and low doses, depending on the condition, age, and overall physiological well-being of the individual.
The continuous use of antidepressants can make your brain dependent on them and stopping them cold turkey will result in withdrawal symptoms.
Trazodone withdrawal syndrome
Trazodone’s abrupt withdrawal can lead to disturbing symptoms associated with Trazodone withdrawal syndrome. This usually occurs if you have been taking the medication for a long period of time and suddenly stop using it one day.
Trazodone increases the levels of certain excitatory neurotransmitters in your brain, like serotonin, to counteract symptoms associated with depression and other mental health conditions (1), and it takes time to do so.
Some people may struggle with adjusting to Trazodone, as the antidepressant may cause side effects during the early course of the treatment. However, they begin to subside within a few weeks when people finally adjust to it.
If you abruptly stop taking the med, your body goes back to the normal amount of the excitatory chemicals.
This makes your brain crave these chemicals, as the normal amounts are not sufficient for your body anymore. This gives rise to a number of disturbing side effects. Common ones include (2):
- Nausea
- Vomiting
- Increased anxiety
- Agitation
- Restlessness
- Nervousness
- Excessive sweating
- Dizziness or lightheadedness
- Tremors
- Muscle twitching
- Fatigue
- Weakness
- Tinnitus
These symptoms can vary from person to person and depend mainly on the dosage strength, duration of treatment, and how abruptly you stopped the medication. This is why it’s best to not stop using Trazodone or any other antidepressant without your doctor’s approval.
How to taper off Trazodone?
The best way to taper off Trazodone is to talk to your healthcare provider as all people are unique in terms of symptoms for which they started taking Trazodone in the first place.
If you have recovered or you’re switching to another antidepressant, it’s best to gradually reduce the dose over a period of 4-5 weeks. Your doctor first reduces your dose, which is called the first step of the taper schedule.
This newly reduced dose is taken for at least a week to make your body settle on that. If your doctor thinks your body needs more time to adjust, you may need to stick to this dose for more than a week.
Once you’re fully adjusted, that’s when your dose is further reduced for another week or so. This way your body doesn’t go through a rapid change.
The beauty of human beings is that our bodies can be adjusted to literally anything if we give them enough time. Once your body starts going back to normal with the least possible dose of antidepressant, that’s when your doctor fully stops the medication.
You may experience some symptoms after the last ever dose of your antidepressant, but they eventually fade away. Remember, a good diet and lifestyle can help you a lot to recover from antidepressant withdrawal.
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References
1.-
MedlinePlus. Trazodone: MedlinePlus drug information [Internet]. Bethesda (MD): National Library of Medicine (US); [updated 2022 Feb 15; cited 2022 Dec 13]. Available from: https://medlineplus.gov/druginfo/meds/a681038.html
2.-
Otani K, Tanaka O, Kaneko S, Ishida M, Yasui N, Fukushima Y. Mechanisms of the development of trazodone withdrawal symptoms. Int Clin Psychopharmacol. 1994 Summer;9(2):131-3. doi: 10.1097/00004850-199400920-00011. PMID: 8056996. Available from: https://pubmed.ncbi.nlm.nih.gov/8056996/
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