OriginalDrugs

Trazodone HCl (Desyrel)

  • Generic Name: Trazodone hydrochloride
  • Brand Names: Desyrel, Trazonil, Oleptro
  • Therapeutic Class: Antidepressant, Phenylpiperazine derivative

What is Trazodone used for?

  • Depression. Some people can not tolerate high doses of trazodone necessary to treat depression because of sedation and drowsiness, especially during the daytime.
  • Short-term treatment for anxiety when mild sedative is needed.
  • Trazodone is the most common off-label prescription for insomnia and sleep difficulties because it is sedating, quite safe, easy to titrate, and inexpensive.
  • Agitation and irritability in elderly persons with dementia.
  • Management of benzodiazepine/alcohol withdrawal4.

Serious drug interactions

  • Antifungals (e.g., itraconazole, ketoconazole), CYP3A4 inhibitors: substantially increased plasma trazodone concentration possible.
  • Serotonergic agents (e.g. SSRIs, SNRIs), tryptophan, St. John’s wort: potential for serotonin syndrome.
  • Antihypertensive agents: possible additive hypotensive effect.
  • Warfarin: increased or decreased prothrombin time.

There is evidence, that trazodone can be safely used together with citalopram or fluoxetine 2. However, excessive sedation is possible.

Trazodone and benzodiazepines, e.g. alprazolam (Xanax), clonazepam (Klonopin): According to the prescribing information, concomitant use of trazodone with benzodiazepines is not contraindicated. However, a caution would be needed if both medications are taken together. Such combination can increase the risk of central nervous system depression. Consult with a doctor before taking both.

Food interactions

Taking trazodone with food reduces peak plasma concentrations, slows the rate of absorption, and increases the extent of absorption.

Grapefruit/grapefruit juice does not interfere with trazodone.

Does Trazodone show up in a panel drug test?

Most standard screening panels won't test for trazodone. It is not a controlled substance.

However, the metabolite of trazodone meta-chlorophenylpiperazine (hallucinogenic drug) can cause false-positive test results on urine drug screens for amphetamines1.

Trazodone in NOT a benzodiazepine. It is unlikely to show up as a false-positive on a drug screen for benzodiazepams.

How long does it take for Trazodone to get out of the system?

Trazodone elimination half-life is 5-9 hours. So the drug should leave your system in 2 to 3 days.

References

  • 1. Baron JM, Griggs DA, Nixon AL, Long WH, Flood JG. The trazodone metabolite meta-chlorophenylpiperazine can cause false-positive urine amphetamine immunoassay results. J Anal Toxicol. 2011 Jul;35(6):364-8. PubMed
  • 2. Prapotnik M, Waschgler R, König P, Moll W, Conca A. Int J Clin Pharmacol Ther. 2004 Feb;42(2):120-4.
  • 3. Logan BK, Costantino AG, Rieders EF, Sanders D. Trazodone, meta-chlorophenylpiperazine (an hallucinogenic drug and trazodone metabolite), and the hallucinogen trifluoromethylphenylpiperazine cross-react with the EMIT®II ecstasy immunoassay in urine. J Anal Toxicol. 2010 Nov;34(9):587-9.
  • 4. Rickels K, DeMartinis N, Rynn M, Mandos L. Pharmacologic strategies for discontinuing benzodiazepine treatment. J Clin Psychopharmacol. 1999 Dec.
  • 5. OLEPTRO (trazodone hydrochloride) PDF
  • 6. Einarson A, Bonari L, Voyer-Lavigne S, Addis A, Matsui D, Johnson Y, Koren G. A multicentre prospective controlled study to determine the safety of trazodone and nefazodone use during pregnancy. Can J Psychiatry. 2003 Mar;48(2):106-10. PubMed

Last updated: February, 2015

Advanced Consumer Info

Trazodone hcl 100 mg
  • Pregnancy Category: C. Trazodone does not increase the rates of major malformations above the baseline rate of 1-3%6.
  • Breastfeeding: Trazodone levels in the breast milk are low and would not be expected to cause any adverse effects in breastfed infants, especially if the baby is older than 2 months or when doses of 100 mg or less are used at bedtime for sleep.
  • Elimination half-life:5-9 hours
  • Mechanism of action: Trazodone is a triazolopyridine derivative, chemically and pharmacologically distinct from other antidepressants. Trazodone’s most potent binding property is 5-HT2A antagonism. It also blocks 5-HT2C receptors to a lesser extent. Its ability to block serotonin transporters is 100 fold less potent than its ability to block 5-HT2A receptors.
  • Reasons to choose Trazodone:
  • 1. Reasonable sleep aid for patients at risk for benzodiazepine abuse. Trazodone has no potential for addiction.
  • 2. Trazodone may be useful for depressed persons with anxiety and insomnia.
  • 3. Trazodone is generally safe, it is not a controlled substance, and vast generic availability makes it less costly than "Z" drugs.
  • 4. Trazodone can intensify erections and sometimes is used to prolong erectile time and turgidity in men with erectile disorder.