What is trazodone used for? (5+ indications)

In this article, we will discuss the uses of trazodone (FDA- and non-FDA-approved uses), what research suggests, the side effects of trazodone, and how to ensure the safe use of trazodone.

What is trazodone used for?

Trazodone is an antidepressant that belongs to the class of serotonin-antagonist reuptake inhibitors (SARI) and is sold under the brand names Desyrel, Oleptro, etc. It is used to treat the following conditions: (1)

Trazodone is FDA-approved to treat: (2)

• Major depressive disorder: Trazodone is FDA-approved to treat major depressive disorders. It works by inhibiting the serotonin transporter and serotonin-type-2 receptors and increasing serotonin, which is involved in mood regulation. Trazodone can be used concomitantly with other antidepressants as well as alone for the treatment of MDD. Recommended dose: 150-375mg/day.

Off-label uses of trazodone: (3)

• Insomnia: Trazodone’s non-FDA-approved use is to treat insomnia. Trazodone’s ability to induce drowsiness makes it effective in treating sleep disorders. Recommended dose: 50-100mg/day. (5)

• Anxiety disorders: Trazodone may be prescribed off-label for the treatment of anxiety disorders. Recommended dose: 75-400mg/day.

• Chronic pain: Trazodone is also used off-label in the treatment of chronic pain as an adjunctive therapy. Recommended dose: 50-300mg/day. (6)

• PTSD: Trazodone may be used off-label for the treatment of PTSD symptoms like anxiety, nightmares, etc. Recommended dose: 50-200mg/day. (5)

• Diabetic neuropathy: Trazodone can also be prescribed off-label to manage diabetic neuropathic pain. Recommended dose: 50-100mg/day. (7)

What does research suggest?

Research suggests that trazodone treats depression without any unwanted effects on sleep, which are usually seen with selective serotonin reuptake inhibitors. A clinical trial published in the Archives of General Psychiatry indicated that trazodone’s efficacy in treating anxiety is comparable to diazepam. (8,9)

A literature review of trazodone’s efficacy in the treatment of insomnia concluded that low-dose trazodone is effective and generally safe for treating insomnia. (10)

One study suggested that high-dose trazodone is effective in the treatment of fibromyalgia, but heart rate should be closely monitored as 21% of patients in the study sample developed tachycardia. (6)

Another study suggested the use of trazodone in low doses to treat the pain associated with diabetic neuropathy. (7)

A study published in the Journal of Pharmacopsychiatry concluded that trazodone is effective in treating PTSD-related insomnia and nightmares, but 12% of study subjects reported priapism with trazodone. (5)

What are the side effects of trazodone?

Trazodone is used to treat various conditions, so it is essential to be aware of its potential side effects. Common side effects may include: (4)

• Diarrhea
• Constipation
• Nausea
• Vomiting
• Nervousness
• Changes in appetite or weight
• Muscle pain
• Weakness or tiredness
• Dizziness or lightheadedness
• Nightmares
• Sexual problems
• Rash
• Itchy eyes
• Dry mouth

Some serious side effects of trazodone include:

• Serotonin syndrome
• Fever
• Fast, pounding, or irregular heartbeat
• Sweating
• Loss of consciousness (coma)
• Chest pain
• Unusual bruising or bleeding
• Nosebleeds
• headache
• Hyponatremia

How to ensure the safe use of trazodone?

Before starting trazodone, consult your healthcare provider to discuss your medical history, underlying conditions, and current medications, including prescriptions, OTC, and supplements. This is crucial in determining the suitability of trazodone and its potential interactions with other drugs.

• Follow the prescribed dosage: Adhering to the prescribed dosage is essential to ensuring the efficacy of trazodone and minimizing the risk of adverse effects associated with it. Do not discontinue or change the dosage and frequency of trazodone without professional guidance.

• Monitoring: Regular monitoring should be done, especially during the initial weeks of treatment. Any unusual symptoms should be immediately reported to your healthcare provider.

• Avoid alcohol and illicit drugs: Trazodone may interact with alcohol and recreational drugs and cause adverse reactions. Patients should avoid alcohol to ensure its safe use.

• Be cautious with other sedatives: Inform your healthcare provider if you are taking other sedatives. as trazodone can cause drowsiness and enhance sedation.

• Emergency preparedness: In cases of severe side effects, overdoses, or allergic reactions, get immediate medical attention.

What are the alternatives to trazodone if it doesn’t suit you?

If treatment with trazodone is not managing your symptoms, your healthcare provider may consider alternative medications for managing the medical condition that trazodone is prescribed for. These medications may include:

• Serotonin and norepinephrine reuptake inhibitors (duloxetine, desvenlafaxine)
• Selective serotonin reuptake inhibitors (sertraline, citalopram)
• Tricyclic antidepressants (amitriptyline)
• Atypical antidepressants (bupropion)
• Muscle relaxants (cyclobenzaprine) for the treatment of fibromyalgia
• Opioids (morphine) for chronic pain

The choice of an alternative medication depends on the disease that trazodone was prescribed for.

From my perspective, trazodone is a valuable tool in the management of depressive disorders, insomnia, and certain other conditions. However, using this medication under the guidance of a healthcare professional who can carefully weigh the benefits and risks based on an individual’s unique circumstances is crucial.

Following prescribed guidelines, monitoring for side effects, and maintaining open communication with healthcare providers can minimize the potential risks.

References