How does this medication work? What will it do for me?

Trazodone belongs to the class of medications called antidepressants. It is used to treat symptoms of depression. It works by affecting the balance of chemicals in the brain that are associated with depression. Trazodone is thought to work by increasing the levels of serotonin in the brain. It may take several weeks before the full benefit of this medication is seen.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

What form(s) does this medication come in?

Trazodone extended-release is no longer being manufactured for sale in Canada and is no longer available under any brand names. This article is being kept available for reference purposes only. If you are using this medication, speak with your doctor or pharmacist for information about your treatment options.

How should I use this medication?

The usual recommended adult dose of trazodone extended-release is 150 mg taken once daily in the evening before bed. After this, the dose may be gradually increased to a maximum of 375 mg daily.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

Trazodone extended-release caplets should be swallowed whole or broken in half along the score line. This medication is controlled-release and is meant to work over a 24-hour period. It should not be chewed or crushed. This will cause the medication to be released into the body at one time.

This medication should be taken at the same time every day, in the evening before bed, and on an empty stomach.

It is important to take this medication exactly as prescribed by your doctor. If you miss a dose, skip the missed dose and continue with your regular dosing schedule. Do not take a dose in the morning to make up for a missed dose the night before. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store this medication at room temperature, protect it from light, and keep it out of the reach of children.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

Who should NOT take this medication?

Do not take this mediction if you are allergic to trazodone or any ingredients of the medication.

What side effects are possible with this medication?

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

  • abdominal pain or discomfort
  • back pain
  • constipation
  • decreased appetite
  • decreased sense of taste
  • decreased sexual desire or ability
  • diarrhea
  • dizziness or lightheadedness
  • drowsiness
  • dry mouth
  • fatigue
  • headache
  • joint pain or swelling
  • muscle ache or stiffness
  • nausea
  • rash
  • tremor

Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

  • agitation
  • blurred vision
  • breast enlargement (in men)
  • breast leakage of milk (in women, even if not pregnant)
  • changes in menstrual cycle
  • confusion
  • decreased hearing
  • dizziness when rising from sitting or lying position
  • fast or pounding heartbeat
  • fever, sore throat, general feeling of being unwell
  • migraine
  • new or worsened emotional or behavioural problems
  • pounding heartbeat
  • problems with balance
  • reduced sexual function
  • ringing in the ears
  • signs of clotting problems (e.g., unusual nosebleeds, bruising, blood in urine, coughing blood, bleeding gums, cuts that don't stop bleeding)
  • signs of a urinary tract infection such as difficult or painful urination, or blood in the urine
  • swelling in the feet or legs
  • symptoms of low sodium in the blood (e.g., tiredness, weakness, or confusion combined with achy uncoordinated muscles)
  • symptoms of mania (e.g., elevated or irritable mood, reduced need for sleep, racing thoughts)
  • uncontrollable movements of the hands or face
  • vision changes

Stop taking the medication and seek immediate medical attention if any of the following occur:

  • painful, prolonged, or inappropriate erection of the penis lasting more than 4 hours
  • seizures
  • symptoms of a serious allergic reaction (swelling of the face or throat, difficulty breathing, wheezing, or itchy skin rash)
  • symptoms of serotonin syndrome (e.g., confusion, fast heartbeat, hallucinations, restlessness, shaking, shivering, sudden jerking of muscles, sweating)
  • thoughts of self-harm or suicide

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Are there any other precautions or warnings for this medication?

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Abnormal bleeding: Other medications similar to trazodone have been known to cause abnormal bleeding, including bleeding in the stomach or intestines. If you have or have had a history of bleeding disorders, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Report any unusual bruising or bleeding to your doctor, especially if you are taking medications that affect blood clotting. These medications include acetylsalicylic acid (ASA), clopidogrel, dipyridamole, nonsteroidal anti-inflammatory drugs (NSAIDs; e.g., ibuprofen or naproxen), other anticoagulant drugs (e.g., warfarin), and certain antipsychotic and antidepressant medications.

Abnormal heart rhythms: This medication can cause abnormal heart rhythms. Certain medications (e.g., sotalol, quinidine, thioridazine, chlorpromazine, droperidol, pimozide, ciprofloxacin, moxifloxacin, mefloquine, pentamidine, tacrolimus) can increase the risk of a type of abnormal heart rhythm called QT prolongation, and should not be used in combination with trazodone.

QT prolongation is a serious life-threatening condition that can cause fainting, seizures, and sudden death. You are more at risk for this type of abnormal heart rhythm and its complications if you:

  • are a woman
  • are older than 65 years of age
  • have a family history of sudden cardiac death
  • have a history of heart disease or abnormal heart rhythms
  • have a slow heart rate
  • have congenital prolongation of the QT interval
  • have diabetes
  • have had a stroke
  • have low potassium, magnesium, or calcium levels
  • have nutritional deficiencies

If you are at risk for heart rhythm problems, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Behaviour changes and suicidal thoughts: Trazodone, like other medications used to treat depression, may worsen symptoms of depression. People taking this medication may feel agitated (restless, anxious, aggressive, emotional, and feeling not like themselves), or they may want to hurt themselves or others. These symptoms may occur within several weeks after starting this medication.

If you experience these side effects or notice them in a family member who is taking this medication, contact your doctor immediately. You should be closely monitored by your doctor for emotional and behaviour changes while taking this medication.

Dizziness: Trazodone can cause severe dizziness, especially when rising from a sitting or lying position. People taking medications that can cause dizziness should rise slowly from sitting or lying down to reduce the possibility of severe dizziness or fainting.

Drowsiness/reduced alertness: This medication may cause drowsiness or dizziness. Do not drive, operate machinery, or perform other potentially hazardous tasks until you have determined how this medication affects you.

Priapism: Trazodone has been associated with prolonged or inappropriate erections (priapism) for a number of men taking this medication. If this occurs, stop taking the medication, and seek immediate medical attention.

Seizures: Seizures have been reported for a small number of people taking trazodone. If you have a history of epilepsy or medical conditions that increase the risk of seizures, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Serotonin syndrome: Rarely, severe, life-threatening reactions are possible when trazodone is combined with other medications that act on serotonin, such as tricyclic antidepressants and serotonin reuptake inhibitors, which are other medications used to treat depression. This is called serotonin syndrome. These combinations should be avoided. Symptoms of a reaction may include muscle rigidity and spasms, difficulty moving, changes in mental state including delirium and agitation. Coma and death are possible.

Stopping the medication: Stopping this medication suddenly may lead to side effects such as agitation, anxiety, and sleep disturbances. If you are thinking of stopping the medication, check with your doctor first. Your doctor may want you to decrease the dose of the medication gradually when it is time to stop taking trazodone.

Pregnancy: This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately.

Breast-feeding: This medication may pass into breast milk. If you are a breast-feeding mother and are taking trazodone extended-release, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children: The safety and effectiveness of trazodone have not been established for people less than 18 years of age.

Seniors: People over 65 years of age may require doses that are lower than those recommended here, to reduce the possibility and severity of side effects.

What other drugs could interact with this medication?

There may be an interaction between trazodone extended-release and any of the following:

  • abiraterone
  • alcohol
  • amphetamines (e.g., dextroamphetamine, lisdexamphetamine)
  • antiarrhythmic medications (e.g., amiodarone, sotalol, quinidine, flecainide)
  • antiepileptic medications (e.g., carbamazepine, phenytoin, valproic acid)
  • antipsychotics (e.g., chlorpromazine, clozapine, haloperidol, olanzapine, quetiapine, risperidone)
  • azole antifungals (e.g., itraconazole, ketoconazole, posaconazole, voriconazole)
  • beta-blocker inhalers (e.g., salmeterol, formoterol)
  • boceprevir
  • bromocriptine
  • buspirone
  • cabergoline
  • cobicistat
  • conivaptan
  • cyclobenzaprine
  • dextromethorphan
  • deferasirox
  • diltiazem
  • domperidone
  • droperidol
  • enzalutamide
  • ergotamine-like medications (e.g., dihydroergoatime, ergotamine, methylergonovine)
  • grapefruit juice
  • HIV non-nucleoside reverse transcriptase inhibitors (NNRTIs; e.g., delavirdine, efavirenz, etravirine, nevirapine)
  • HIV protease inhibitors (e.g., atazanavir, indinavir, ritonavir, saquinavir)
  • levomilnacipran
  • linagliptin
  • linezolid
  • lithium
  • macrolide antibiotics (e.g., clarithromycin, erythromycin)
  • mefloquine
  • methylene blue
  • metoclopramide
  • mifepristone
  • mirtazapine
  • monoamine oxidase inhibitors (MAOIs; e.g., maprotiline, moclobemide, phenelzine, selegiline, tranylcypromine)
  • nefazodone
  • nicardipine
  • opioid pain medications (e.g., codeine, morphine)
  • phenobarbital
  • primaquine
  • primidone
  • protein kinase inhbitors (e.g., dasatinib, imatinib, lapatinib, pazopanib, sunitinib)
  • quinolone antibiotics (e.g., ciprofloxacin, levofloxacin, moxifloxacin)
  • quinidine
  • quinine
  • rifabutin
  • rifampin
  • selective serotonin reuptake inhibitors (SSRIs; e.g., citalopram, fluoxetine, paroxetine, sertraline)
  • serotonin antagonists (anti-emetic medications; e.g., granisetron, ondansetron)
  • serotonin/norepinephrine reuptake inhibitors (SNRIs; e.g., desvenlafaxine, duloxetine, venlafaxine)
  • simeprevir
  • St. John's wort
  • tacrolimus
  • telaprevir
  • tetrabenzine
  • tricyclic antidepressants (e.g., amitriptyline, desipramine, trimipramine)
  • "triptan" migraine medications (e.g., sumatriptan, zolmitriptan)
  • tryptophan
  • verapamil
  • warfarin

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

  • stop taking one of the medications,
  • change one of the medications to another,
  • change how you are taking one or both of the medications, or
  • leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.

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