Home Drug Guide Trazodone Hydrochloride

Drug Guide

Generic Name

Trazodone Hydrochloride

Brand Names Desyrel, Oleptro, Trialodine, Raldesy

Classification

Therapeutic: Antidepressant, Sedative

Pharmacological: Serotonin antagonist and reuptake inhibitor (SARI)

FDA Approved Indications

  • Major depressive disorder
  • Off-label uses include insomnia and anxiety

Mechanism of Action

Trazodone acts primarily by inhibiting the reuptake of serotonin (5-HT), and antagonizing serotonin 5-HT2 receptors, contributing to its antidepressant and sedative effects.

Dosage and Administration

Adult: Initially 150 mg/day in divided doses or as a single dose at bedtime; dose may be increased slowly based on response and tolerability, up to a maximum of 400 mg/day.

Pediatric: Not approved for pediatric use.

Geriatric: Start at a lower dose due to increased sensitivity; usual starting dose is 75 mg at bedtime, titrate as needed.

Renal Impairment: Adjust dose cautiously; consider lower starting doses.

Hepatic Impairment: Use with caution; monitor closely, start at lower dose.

Pharmacokinetics

Absorption: Well-absorbed after oral administration.

Distribution: Widely distributed, protein binding approximately 89%.

Metabolism: Hepatic via extensive first-pass metabolism; active metabolite is m-CPP.

Excretion: Metabolites excreted mainly in urine.

Half Life: Approximately 7-10 hours for the parent compound, longer for metabolites.

Contraindications

  • History of hypersensitivity to trazodone
  • Use with other serotonergic drugs unless managed carefully.

Precautions

  • Risk of priapism, orthostatic hypotension, sedation, and suicidal thoughts, especially in young adults and during initial treatment. Use cautiously in patients with cardiac disease, seizures, or history of bipolar disorder.

Adverse Reactions - Common

  • Sedation, dizziness (Common)
  • Dry mouth, blurred vision (Common)
  • Nausea, vomiting (Common)

Adverse Reactions - Serious

  • Priapism (Rare)
  • Serotonin syndrome (when combined with other serotonergic agents) (Rare)
  • Arrhythmias, QT prolongation (Rare)
  • Orthostatic hypotension (Less common)

Drug-Drug Interactions

  • Other serotonergic drugs (e.g., SSRIs, SNRIs, MAOIs) increase risk of serotonin syndrome.
  • CYP3A4 inhibitors may increase trazodone levels.
  • CYP3A4 inducers may decrease effectiveness.

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor mental status, signs of suicidal ideation, cardiovascular status, and for adverse effects such as sedation and hypotension.

Diagnoses:

  • Risk for injury related to orthostatic hypotension or sedation.
  • Impaired sleep pattern.

Implementation: Administer at bedtime to reduce daytime sedation. Monitor blood pressure and mental status. Avoid alcohol and CNS depressants.

Evaluation: Assess for improvement in depressive symptoms, sleep quality, and side effects.

Patient/Family Teaching

  • Take medication exactly as prescribed.
  • Do not discontinue abruptly to avoid withdrawal.
  • Caution regarding sedation and operating machinery.
  • Report any signs of priapism, or unusual mood changes.
  • Avoid alcohol and other CNS depressants.

Special Considerations

Black Box Warnings:

  • Risk of suicidal thoughts and behaviors in children, adolescents, and young adults.
  • Potential for arrhythmias, including QT prolongation.

Genetic Factors: Genetic variations affecting CYP3A4 may influence drug levels.

Lab Test Interference: None known.

Overdose Management

Signs/Symptoms: Drowsiness, hypotension, rapid heart rate, seizures, priapism, and possible coma.

Treatment: Supportive care, monitoring vital signs, activated charcoal if ingested recently, and symptomatic treatment. Cardiovascular monitoring for arrhythmias.

Storage and Handling

Storage: Store at room temperature, 20°C to 25°C (68°F to 77°F).

Stability: Stable in original container. Protect from light and moisture.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.