Trazodone (Desyrel) Facts

• Generic name: trazodone hydrochloride
• Brand/Trade names: Desyrel, Trazon, Trialodine
• Dosages: Tablets 50 mg, 100 mg, 150 mg
• Pharmacologic category: antidepressant, triazolopyridine derivative, 5-HT(2) antagonist and 5-HT reuptake inhibitor
• FDA approved: December 24, 1981
• Habit forming? No
• Pregnancy risk factor: C

Trazodone is an antidepressant medication. It was discovered in Italy by the Angelini research laboratories.

Trazodone is a psychoactive compound with sedative, anxiolytic, and antidepressant properties. Trazodone has less prominent anticholinergic (dry mouth, constipation, tachycardia) and adrenolytic (hypotension, male sexual problems) side effects than most tricyclic antidepressants. The incidence of nausea and vomiting observed with Trazodone is relatively low compared to SSRIs.

Trazodone is a sedating antidepressant, widely used for insomnia. It is especially effective for the treatment of insomnia caused by other antidepressants [1]. However, Trazodone is used for the treatment of insomnia even in the absence of a depressive disorder. Polysomnographic studies of people with various kinds of insomnia have found that trazodone's main effect on sleep architecture is an increase in slow-wave (stages 3 and 4) sleep [11, 12].

Usually, the starting dose for insomnia is 25 mg or 50 mg at bedtime. The dose can be increased if necessary up to 100 mg. There is little need to increase the dose above 100 mg for this indication. It's sleep aid effect starts within 1-2 hours and usually lasts about 8 hours.

Important facts:

• Take trazodone with food. Total tazodone absorption may be up to 20% higher when it is taken with food rather than on an empty stomach.
• Trazodone has a narrow "window" of hypnotic effect of about 1-1.5 hour, within which you should go to bed. If you miss that window, you may feel very sleepy but unable fall asleep.

Trazodone may cause congested nose, feelings of tiredness and grogginess (frequently described as hangover) on the next morning. However it's advantage is that unlike most sleeping pills, it is not addictive and not habit forming.

• Elimination half-life: 3-6 hours
• Metabolism: Hepatic via CYP3A4 to an active metabolite (mCPP)
• Excretion: Primarily urine (80%); secondarily feces (20%)

• Effective antidepressant in treating major depressive disorder
• Has no risk of addiction
• Has a long safety record
• Safe in overdose
• Low levels of anticholinergic effects, such as dry mouth, blurred vision, bowel movement disturbance, and delayed urine flow [9]
• Low cost
• Equal antidepressant efficacy with amitriptyline, imipramine, and fluoxetine
• Increased pain threshold [5]
• Can be safely used in combination with SSRIs [8]

• potential for drug interactions with inducers and/or inhibitors of CYP3A4 [7]
• risk of drug-induced priapism due to alpha-adrenergic antagonist properties [10]

Whereas trazodone is not approved to treat insomnia, relatively few studies actually support its efficacy and safety. Trazodone may be of advantage in depressed patients with sleep difficulties. Trazodone is effective in the treatment of antidepressant-associated insomnia.

• Panic/Anxiety [2]
• Insomnia [1]
• Bipolar depression
• Chronic fatigue
• Fibromyalgia
• Eating disorders
• Alcohol withdrawal [3]

Trazodone is a serotonin reuptake inhibitor and is also a 5-HT2 receptor antagonist. However, in contrast to the selective serotonin reuptake inhibitors, trazodone's antidepressant effects may be due to its antagonistic effect at the 5-HT2 receptor site. It causes adrenoreceptor subsensitivity, and induces significant changes in 5-HT presynaptic receptor adrenoreceptors. This agent also blocks histamine (H1) and alpha1-adrenergic receptors.

• Trazodone discussion: http://www.drugs.com/forum/featured-drugs/trazodone-21084.html
• Trazodone discussion: http://www.drugs.com/forum/featured-drugs/trazadone-41290.html

• 1. Nierenberg AA, Adler LA, Peselow E, Zornberg G, Rosenthal M. Trazodone for antidepressant-associated insomnia. Am J Psychiatry. 1994 Jul;151(7):1069-72. PubMed
• 2. Mavissakalian M, Perel J, Bowler K, Dealy R. Trazodone in the treatment of panic disorder and agoraphobia with panic attacks. Am J Psychiatry. 1987 Jun;144(6):785-7. PubMed
• 3. Roccatagliata G, Albano C, Maffini M, Farelli S. Alcohol withdrawal syndrome: treatment with trazodone. Int Pharmacopsychiatry. 1980;15(2):105-10. PubMed
• 4. Haria M, Fitton A, McTavish D. Trazodone. A review of its pharmacology, therapeutic use in depression and therapeutic potential in other disorders. Drugs Aging. 1994 Apr;4(4):331-55. PubMed
• 5. Silvestrini B. Trazodone: from the mental pain to the "dys-stress" hypothesis of depression. Clin Neuropharmacol. 1989;12 Suppl 1:S4-10. PubMed
• 6. Dossier Trazodone. 15/03/2007 . Available at: Angelini.it
• 7. Rotzinger S, Fang J, Baker GB. Trazodone is metabolized to m-chlorophenylpiperazine by CYP3A4 from human sources. Drug Metab Dispos. 1998 Jun;26(6):572-5. PubMed
• 8. Prapotnik M, Waschgler R, Ko"nig P, Moll W, Conca A. Therapeutic drug monitoring of trazodone: are there pharmacokinetic interactions involving citalopram and fluoxetine? Int J Clin Pharmacol Ther. 2004 Feb;42(2):120-4. PubMed
• 9. Gershon S, Newton R. Lack of anticholinergic side effects with a new antidepressent--trazodone. J Clin Psychiatry. 1980 Mar;41(3):100-4. PubMed
• 10. Abber JC, Lue TF, Luo JA, Juenemann KP, Tanagho EA. Priapism induced by chlorpromazine and trazodone: mechanism of action. J Urol. 1987 May;137(5):1039-42. PubMed
• 11. Parrino L, et al. Clinical and polysomnographic effects of trazodone CR in chronic insomnia associated with dysthymia. Psychopharmacology (Berl) 1994;116:389-395. PubMed
• 12. Montgomery I, et al. Trazodone enhances sleep in subjective quality but not in objective duration. Br J Clin Pharmacol 1983;16:139-144. PubMed
• U.S. Food and Drug Administration. Trazodone U.S. Prescribing Information. Available at (PDF format): Prescribing Information