Does Trazadone interact with other drugs?

Discussion in 'Fibromyalgia Main Forum' started by marw, Feb 18, 2006.

  1. marw

    marw New Member

    My doc once recommended Trazadone, but at that point I was so frightened of these drugs that I just refused to try it. I had horrible reactions to all SSRI's, Neurontin, all anti-depressents, Topamax, and a whole long list. The only thing I have successfully taken is Ativan or Valium or Vicodin.

    An info appreciated.

    Thanks,
    Margaret
  2. PVLady

    PVLady New Member

    I have been experimenting with Trazodone. It is supposed to help sleep but I am seeing if it will help depression. (I don't like other anti-depressants).

    When I took it for sleep I was wide awake. I take Ambien for sleep.

    I don't believe Trazodone is related to SSRI's - I have read one common side effect is heart rhythym disturbances, like fast heartbeat, or irregular heartbeat if you are prone to have that problem.

    You might tell your pharmacist what you are now taking and ask if Trazodone will be a problem with your other meds.


    Below is a list of the adverse reactions, etc. -

    Pharmacology
    Antidepressant

    Trazodone is a psychoactive compound with sedative and anti-depressant properties. Its mechanism of action in humans is not clear.

    Trazodone is well absorbed after oral administration with mean peak plasma levels obtained within 0.5 to 2 hours after ingestion. Absorption is somewhat delayed and enhanced by food. The mean plasma elimination half-life is 4.4 hours for the period from 3 to 10 hours after dosing, and 7 to 8 hours for the period from 10 to 34 hours. The drug is extensively metabolized with 3 or 4 major metabolites having been identified in man. Approximately 60 to 70% of C14-labelled trazodone was found to be excreted in the urine within 2 days and 9 to 29% in feces over 60 to 100 hours. Trazodone is 89 to 95% protein bound in vitro at concentrations attained with therapeutic doses.

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    Indications
    For the symptomatic relief of depressive illness.

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    Contraindications
    Known hypersensitivity to trazodone.

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    Warnings
    Trazodone has been associated with the occurrence of priapism. In approximately 33% of the cases reported, surgical intervention was required and, in a portion of these cases, permanent impairment of erectile function or impotence resulted. Male patients with prolonged or inappropriate erections should immediately discontinue the drug and consult their physician. If the condition persists for more than 24 hours, it would be advisable for the treating physician to consult a urologist or appropriate specialist in order to decide on a management approach. Recent clinical studies in patients with pre-existing cardiac disease indicate that trazodone may be arrhythmogenic in some patients in that population. Arrhythmias identified include isolated PVC's, ventricular couplets, and in 2 patients short episodes (3 to 4 beats) of ventricular tachycardia. There have also been several post-marketing reports of arrhythmias in trazodone-treated patients who have pre-existing cardiac disease and in some patients who did not have pre-existing cardiac disease. Until the results of prospective studies are available, patients with pre-existing cardiac disease should be closely monitored, particularly for cardiac arrhythmias. Trazodone is not recommended for use during the initial recovery phase of myocardial infarction.

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    Precautions
    The possibility of suicide in depressed patients remains during treatment and until significant remission occurs. Therefore, the number of tablets prescribed at any one time should take into account this possibility, and patients with suicide ideation should never have access to large quantities of trazodone.

    Episodes of grand mal seizures have been reported in a small number of patients. The majority of these patients were already receiving anticonvulsant therapy for a previously diagnosed seizure disorder.

    Occupational Hazards:
    Since trazodone may impair the mental and/or physical abilities required for performance of potentially hazardous tasks, such as operating an automobile or machinery, the patient should be cautioned not to engage in such activities while impaired.

    Drug Interactions:
    Trazodone may enhance the response to alcohol and the effects of barbiturates and other CNS depressants and patients should be cautioned accordingly.

    Increased serum digoxin and phenytoin levels have been reported to occur in patients receiving trazodone concurrently with either of those 2 drugs. Little is known about the interaction between trazodone and general anesthetics; therefore, prior to elective surgery, trazodone should be discontinued for as long as clinically feasible.

    Because it is not known whether an interaction will occur between trazodone and MAO inhibitors, administration of trazodone should be initiated very cautiously with gradual increase in dosage as required, if an MAO inhibitor is given concomitantly or has been discontinued shortly before medication with trazodone is instituted.

    Trazodone may cause hypotension including orthostatic hypotension and syncope; caution is required if it is given to patients receiving antihypertensive drugs and an adjustment in the dose of the antihypertensive medication may be required.

    Because of the absence of experience, concurrent administration of electro-shock therapy should be avoided.

    Pregnancy and Lactation:
    Since the safety and use of trazodone in pregnant women has not been established, it should not be used in women of childbearing potential unless in the opinion of the physician the expected benefits justify the potential risk to the fetus. Since trazodone and/or its metabolites have been detected in the milk of lactating animals, it should not be administered to nursing mothers unless the potential benefits justify the possible risks to the child.

    Children:
    The safety and effectiveness of trazodone in children below the age of 18 have not been established.

    Laboratory tests:
    It is recommended that white blood cell and differential counts should be performed in patients who develop sore throat, fever, or other signs of infection or blood dyscrasia and trazodone should be discontinued if the white blood cell or absolute neutrophil count falls below normal.

    Hyperprolactinemia and breast tumors:
    There is sufficient experimental evidence to conclude that chronic administration of those psychotropic drugs, such as trazodone, which increase prolactin secretion has the potential to induce mammary neoplasms in rodents under appropriate conditions. Tissue culture experiments indicate that approximately 33% of human breast cancers are prolactin dependent in vitro, a factor of potential importance if the prescription of these drugs is contemplated in a patient with a previously detected breast cancer. Although disturbances such as galactorrhea, amenorrhea, gynecomastia and impotence have been reported, the clinical significance of elevated serum prolactin levels or increased secretion and turnover are unknown for most patients. Neither clinical studies nor epidemiological studies conducted to date, however, have shown an association between administration of these drugs and mammary tumorigenesis: Available evidence is considered too limited to be conclusive at this time.

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    Adverse Effects
    The most common adverse reactions encountered are drowsiness, nausea/vomiting, headache and dry mouth. Adverse reactions reported include the following:

    Behavioral:
    Drowsiness, fatigue, lethargy, retardation, lightheadedness, dizziness, difficulty in concentration, confusion, impaired memory, disorientation, excitement, agitation, anxiety, tension, nervousness, restlessness, insomnia, nightmares, anger, hostility and, rarely, hypomania, visual distortions, hallucinations, delusions and paranoia.

    Neurologic:
    Tremor, headache, ataxia, akathisia, muscle stiffness, slurred speech, retarded speech, vertigo, tinnitus, tingling of extremities, paresthesia, weakness, grand mal seizures (see Precautions), and, rarely impaired speech, muscle twitching, numbness, dystonia and involuntary movements.

    Autonomic:
    Dry mouth, blurred vision, diplopia, miosis, nasal congestion, constipation, sweating, urinary retention, increased urinary frequency and incontinence.

    Cardiovascular:
    Orthostatic hypotension, hypertension, tachycardia, palpitations, shortness of breath, apnea, syncope, arrhythmias, prolonged P-R interval, atrial fibrillation, bradycardia, ventricular ectopic activity (including ventricular tachycardia), myocardial infarction and cardiac arrest.

    Gastrointestinal:
    Nausea, vomiting, diarrhea, gastrointestinal discomfort, anorexia, increased appetite.

    Endocrine:
    Priapism (see Warnings), decrease and, more rarely, increase in libido, weight gain and loss, and rarely, menstrual irregularities, retrograde ejaculation and inhibition of ejaculation.

    Allergic or toxic:
    Skin rash, itching, edema, and, rarely, hemolytic anemia, methemoglobinemia, liver enzyme alterations, obstructive jaundice, leukocytoblastic vasculitis, purpuric maculopapular eruptions, photosensitivity and fever.

    Miscellaneous:
    Aching joints and muscles, peculiar taste, hypersalivation, chest pain, hematuria, red, tired and itchy eyes.

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    Overdose
    Symptoms:
    Overdosage of trazodone may cause an increase in incidence or severity of any of the reported adverse reactions, e.g. hypotension and excessive sedation. In one known suicide attempt, the patient presented with symptoms of drowsiness and weakness 3 hours after ingesting 7.5 g (12.5 times the maximum daily dose) of trazodone. Recovery was uneventful. Death by deliberate or accidental overdosage has not been reported.

    Treatment:
    There is no specific antidote for trazodone. Management of overdosage should, therefore, be symptomatic and supportive. Any patient suspected of having taken an overdosage should be admitted to hospital as soon as possible and the stomach emptied by gastric lavage. Forced diuresis may be useful in facilitating elimination of the drug.

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    Dosage
    Dosage should be initiated at a low level and increased gradually noting carefully the clinical response and any evidence of intolerance. It should be kept in mind that there may be a lag in the therapeutic response. Increasing the dosage rapidly does not normally shorten this latent period and may increase the incidence of side effects.

    Usual adult dosage:
    The recommended initial dose is 150 to 200 mg daily, in 2 or 3 divided doses. Trazodone should be taken shortly after a meal or light snack in order to reduce the incidence of adverse reactions. The initial dose may be increased according to tolerance and response by increments of 50 mg, usually up to 300 mg daily in divided doses. In some patients, doses up to 400 mg daily and rarely up to 600 mg daily in hospitalized patients, may be required. Occurrence of drowsiness may require the administration of a major portion of the daily dose at bedtime or a reduction of dosage. Once an adequate response has been achieved, the dosage may be gradually reduced, with adjustment depending on therapeutic response. During prolonged maintenance therapy the dosage should be kept at the lowest effective level.

    Use in the elderly:
    If used in the elderly, doses not exceeding one-half the recommended adult dosage should be used, with adjustments made depending on tolerance and response.

    Because safety and effectiveness in children have not been established trazodone is not recommended in the pediatric age group.

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    Supplied
    Desyrel:
    Each orange, round, film-sealed, scored tablet contains: Trazodone hydrochloride 50 mg. Bottles of 100 and 250.

    Each white, round, film-sealed, scored tablet contains: Trazodone hydrochloride 100 mg. Bottles of 100.

    Desyrel Dividose:
    Each orange rectangular-shaped, trisected and bisected tablet contains: Trazodone hydrochloride 150 mg. Each tablet can be broken accurately to provide any of the following dosages: 50 mg (1/3 tablet), 75 mg (1/2 of a tablet), 100 mg (2/3 of a tablet), 150 mg (entire tablet). To break a Dividose tablet accurately and easily, hold the tablet between your thumbs and index fingers, close to the appropriate score (groove). Then with the tablet score facing you, apply pressure and snap the tablet segments apart. Bottles of 100.

  3. janieb

    janieb New Member

    Margaret,

    I take Trazadone because it's the only thing that helps my pain and I've been taking it for several years.

    A few months ago I went to my doctor for depression. They evaluated me and gave me a prescription. Fortunately, I read all the sheets the pharmacist gave me and it said not to take it if you were using Trazadone. Since I needed the Trazadone more, I didn't take the depression medication. I've now learned two things. Depression is part of the fibro and two, Trazadone does not work well with very many other medications.

    Hope this is helpful and not too depressing.

    Mary
  4. janieb

    janieb New Member

    Sorry, Margaret. The medication I'm taking is tramadol, not Trazadone.

    Mary
  5. TwinMa

    TwinMa New Member

    www.drugdigest.org

    You can enter in all the drugs/herbals/supplements you are taking as well as Trazadone and see if any interactions come up.

    Katy
  6. marw

    marw New Member

    Thanks, everyone, for the really good info you gave me.

    PVLady, I was amazed that you could get so much information copied down here for me, and very grateful. I could maybe read it on the directions (I actually filled the script, but never took it), but the print is just too small, and I didn't. So much easier to read it here.

    It sounds like this may have too many side effects for me. I know they all do, but when I start reading the list, they are the very same ones I usually have....of course the only way to know would be to try, I think.

    WakeMeUp, thank you, thank you, for telling about the Benadryl, because I forgot to say that is what I use now, and I would have unknowingly taken them together.

    Katy, I copied the web site in my Fibro Folder in the computer. WHat a great thing to have to check for drug interactions! Thanks for that very much.

    I think I'll talk it over with the Pharmacist and the doc both, because when this was first prescribed, I was not taking Vicodin. THe Ativan sounds like it would be O.K.
    But maybe not the other. And I really have to have the Vicodin, unless this also works on pain as well as sleep. THe doc was going to give it to me for sleep.

    I confess I am really bad about telling a doc I will try a drug, then losing my nerve. But I just had so many bad experiences. I almost got hit by a car one time, because I forgot how to cross the street, and some kind stranger came and got me and led me across, then got a taxi for me. I did remember where I lived. This was what Wellbutrin did. I learned then, not to leave the house until I knew what was going to happen.

    I don't think I am depressed, although I know that is usually part of the Fibro. What I have is acute anxiety. Yet I also could not take Paxil or any of those things.

    I guess I will just keep experimenting carefully as I feel I have the courage to do it.

    One thing some of you who have Migraine might like to know, is that the Triptan meds, which I can and do take for the Migraine, do interact with antidepressents somewhat. I believe triptans have some effect on the serotonin, but not on the same receptors. I'm not completely sure about this, so it is something to be aware of and to check out. One Neurologist that I saw suggested that I use a drug called FROVA (a triptan) every 3 days for Fibro, even though it would not normally be prescribed for that. I didn't because FROVA has such a long half-life in the body...2 or 3 days, I think. And I could never go that long without Imitrex if I got a headache, and you cannot take both.

    Thanks again for the helpful info.

    I will post the results if I decide to try the Trazadone.

    Margaret
  7. coffeecake

    coffeecake New Member

    I was on Trazadone close to two years. I started having problems with slurred speech and I now suffer from irregular heart beats and I now have to take Flecanide to control the arrythmias. I had to go to several doctors and was hospitalized several times before I got the right meds to control my arrythmias. I did not realize that the Trazadone might be responsible for my heart problems until I read the post. I thought it was the oxycontin that I was taking for pain control. Now I'm not so sure it was the oxycontin. The slurring of my speech stopped after I stop taking Trazadone. I hope this helps
  8. Jeanette62

    Jeanette62 New Member

    Thanks for posting this info. I've been contemplating taking this, but didn't know what to do. The other 2 I tried Nortriptyline and Amitriptyline both caused me to be wide awake and have a racing heart rate. It scares me to try it. I'll have to read it again when I'm not so sleepy.

    Jeanette
  9. futurehope

    futurehope New Member

    I have taken Trazadone for sleep and I have to tell you that this KNOCKED ME OUT!!! It works well (at least for myself for sleep).

    I do not know about taking this during the day, I do not think I could function normally. I would probably sleep ALL of the time. Your body might be different though.

    Hope this helps!!

    Love and prayers:
    Brenda
  10. marw

    marw New Member

    Hi All!

    I really appreciate getting all this info. I don't know yet whether I'm going to try the trazdone or not. But I am so glad to have this info about it, so I'm not "flying blind" as it were. I have a good heart and would really hate to risk that (especially as I have COPD) but I really, really need to sleep.

    Right now I'm getting over this sinus infection, so I will wait until I feel better to start a new drug. I'll let you know what happens.

    Thanks,
    Margaret
  11. elsa

    elsa New Member

    Hi Margaret ....

    I took trazadone back in the day for sleep probs .... Bad experience for me as it made me more stupid then a sake full of hammers. Didn't need any more help in that department you ya know?!?

    Trazadone is a TRI-AD ... classified as a triazolopyridine thus the TRI AD abbreviation, lol. This class of ADs inhibit serotonin reuptake same as SSRI's do so be careful if you are taking both.

    Side effects, major ones .... sleepiness, excessive daytime sleepiness, major sexual dysfunction, headache, dry mouth, constipation and weight gain.

    It is rx'ed mainly for major depressive disorder but also sometimes for sleep. It is not the best choice for anxiety disorder.

    Since the advent of SSRI's this is not as rx'ed as commonly as once was for depression ... SSRI's (some better then others) have less side effects then the TRI-AD group making it a better tolerated ... meaning patient has a more likely chance of staying on them & with treatment.

    Look out for any supplement / herb you may be taking that also effecrs serotonin levels, IE 5-htp, sam-e, l-trytophan. Combining these could lead to serotonin syndrome and you don't want that.

    Good luck with this. I eventually found I was having nightmares along with my other symptoms. It made me too numb ... no emotion what so ever ... a walking zombie.

    There are many who have been helped with trazadone .... I just did not fall into that category. Hope this helps ...

    Elsa
  12. kalley167

    kalley167 New Member

    for a few years now and have had no ill effects. The Pharmacists says it actually quite mild in the side effects. I take 150 mg. And on bad nights I also take Zanaflex. I sleep alot better than before Trazadone. And my plus side no weight gain as some other sleep aids and antidepressants cause. I am actually losing weight.So far since Jan 2005 i have been able to lose 21lbs. Makes me feel so much better. I was on meds before that caused the gain.
  13. 1sweetie

    1sweetie New Member

    I was given Trazodone for sleep in 1992 for sleep to aid in my battle with migraines. As the years went by I slowly decreased the mgs to 100 mgs. When I became ill with CFS/FM, my family dr.and a neurologist from Duke decided that I must stop taking the medicine and my life might be better. For 4 miserable months, I obeyed. My sleep quality which was bad enough because of pain and a bad case of restless leg syndrome went to almost non existent. The CFS/FM specialist put me back Trazodone. She prescribed 1 to 2 50 mg pills at bedtime. It helps so much but with everything that is going on with my health & lack of sleep other meds were added. I take the smallest amt of Mirapex available, Klonopin, 1 50 mg of Trazodone & Oxycontin (for pain & restless legs). I still was not sleeping and one of my doctors added 50mg of Lyricia to be taken for 4 days and then I was to increase the Lyricia to 3 times daily for pain in my feet & hands. The first night I added the 50 mg of Lyricia, I slept to 10 am and did not wake at all that night. All nights have not been that perfect but this combination has been a blessing to me. Also, per my doctor's Trazodone is not a good antidepressant. For it to be effective for depression you would have to take so much that all you would do is sleep. Best of luck with your decision.
  14. HagerTX

    HagerTX New Member

    I took Trazodone for a few months in late 2002 & early 2003. It's a modified tricyclic antidepressant whatever that means, but I suspect it's been around a while.

    Odd thing that happened on Trazodone--I had been on a half dose of Paxil (~10mg) for well over a year. Although I had some anxiety and depression relief, the Paxil made me very jittery and restless in a way so i never could take more than 10mg of it. When prescribed Trazodone, the "SSRI jitters" largely went away and was able to move up to 50mg of Paxil CR for a time. The Trazodone did however aggravate my stomach and give me a dull headache most of the time, so I quit it.