Trazodone HCl

A to Z Drug Facts

Trazodone HCl

	Action
	Indications
	Contraindications
	Route/Dosage
	Interactions
	Lab Test Interferences
	Adverse Reactions
	Precautions
Patient Care Considerations
	Administration/Storage
	Assessment/Interventions
	Patient/Family Education

(TRAY-zoe-dohn HIGH-droe-KLOR-ide)

Desyrel, Desyrel Dividose, Alti-Trazodone, Alti-Trazodone Dividose, Apo-Trazodone, Apo-Trazodone D, Novo-Trazodone, Nu-Trazodone, Nu-Trazodone-D, PMS-Trazodone, Trazorel

Class: Antidepressant

Action Undetermined; may affect serotonin uptake at presynaptic neuronal membrane.

Indications Treatment of depression. Unlabeled use(s): Treatment of neurogenic pain, aggression, panic disorder, cocaine withdrawal.

Contraindications Hypersensitivity to trazodone; initial recovery phase of MI.

Route/Dosage

ADULTS: PO 150 mg/day in divided doses initially; increase in 50 mg increments up to maximum of 400 mg per day (outpatients) or 600 mg per day (inpatients). ELDERLY PATIENTS: PO Start with 75 mg/day in divided doses.

Interactions

Alcohol, barbituates, CNS depressants: CNS depressant effects may be additive. Carbamazepine: Plasma concentrations of trazodone and its active metabolite may be decreased, producing a decrease in therapeutic effect. Fluoxetine: May increase trazodone serum levels. Hypotensive agents: May cause additive hypotensive effects. MAO inhibitors: It is unknown whether interactions may take place. Initiate trazodone therapy cautiously if patient is currently taking or has recently stopped taking MAO inhibitors. Phenothiazines: Elevated trazodone serum concentrations have occurred, increasing the pharmacologic and toxic effects. SSRIs: A “serotonin syndrome,” including irritability, increased muscle tone, shivering, myoclonus, and altered consciousness may occur.

Lab Test Interferences None well documented.

Adverse Reactions

CV: Hypertension; orthostatic hypotension; shortness of breath; yncope; tachycardia; palpitations; chest pain; MI; arrhythmias; sinus bradycardia; onduction block; cardiac arrest; CHF; conduction block. CNS: Anger; hostility; nightmares/vivid dreams; confusion; disorientation; ecreased concentration; dizziness; drowsiness; excitement; fatigue; headache; nsomnia; impaired memory; nervousness; tingling; tremors; convulsions; incoordination; aresthesia; agitation; anxiety; grand mal seizures; hallucinations/delusions. EENT: Blurred vision; “red eyes;” ringing in ears; nasal or sinus congestion; tinnitus. GI: Abdominal/gastric disorders; unpleasant taste; dry mouth; nausea; vomiting; iarrhea; constipation; flatulence. GU: Altered libido; impotence; priapism; urinary retention; breast enlargement or engorgement; delayed urine flow; early menses. HEMA: Anemia; hemolytic anemia; decreased WBC. HEPA: Jaundice; increased LFTs. OTHER: Hypersensitivity reaction (eg, skin conditions, edema, rash, itching, purpura); muscle aches and pains; decreased appetite; sweating; changes in weight; malaise; allergic skin condition/edema; nasal/sinus congestion; akathisia; llergic reaction; alopecia; anemia; aphasia; apnea; ataxia; cardiac arrest; ardiospasm; cerebrovascular accident; chills; cholestatis; clitorism; diplopia; xtrapyramidal symptoms; hematuria; hemolytic anemia; hirsutism; hyperbilirubinemia.

Precautions

Pregnancy: Category C. Lactation: Excreted in breast milk. Children: Safety and efficacy in children < 18 yr not established. Cardiac disease: Not recommended for patients in acute recovery from MI. Trazodone may also cause arrhythmias; patients with preexisting cardiac disease should be closely monitored. Lab tests: Patients who develop fever, sore throat or other signs of infection during therapy should have white blood cell count and differential taken, because trazodone may lower WBC and neutrophil counts. Priapism: Priapism (prolonged, painful inappropriate penile erection) has been reported. Condition may require surgical intervention. Any patient experiencing inappropriate or prolonged erection should stop taking trazodone immediately and notify physician. Suicide: Patients at risk should be closely monitored and not be given access to excessive quantities.

PATIENT CARE CONSIDERATIONS

Administration/Storage

Administer with meals or with light snack.
Increase dosage gradually; drowsiness may require administration of bedtime dosage or reduced dosage.
Assess for initial improvement in 1 wk, with optimal effect evident within 2–4 wk of therapy.
Store in tight, light-resistant container at room temperature.

Assessment/Interventions

Obtain patient history, including drug history and any known allergies.
Obtain blood studies (CBC, differential) and hepatic studies in patients undergoing long-term therapy.
Assess mood and mental status before and during therapy.
Check to be sure oral medication is taken.
Implement oral hygiene measures in presence of dry mouth or unpleasant taste.
Implement safety precautions to prevent injury, especially during initial therapy until effect is known. Assist with ambulation.
Monitor patient for urinary retention.
Monitor BP and pulse throughout therapy.
Monitor ECG in patients with cardiac disorders.
Monitor weight weekly.
Monitor for side effects, particularly drowsiness, dizziness, lightheadedness, changes in BP or pulse, dry mouth, GI disturbances, altered libido.
Assess for hypotension, particularly when used concurrently with antihypertensives and nitrates.

OVERDOSAGE: SIGNS & SYMPTOMS
	Priapism, respiratory arrest, seizures, ECG changes, death, drowsiness, vomiting

Patient/Family Education

Tell patient that maximal effect may not be evident for up to 4 wk.
Instruct family to monitor mood during therapy. Observe for suicidal tendencies.
Advise patient to check weight weekly because appetite may increase with drug.
Tell patient taking antihypertensives or nitrates about potential for additive hypotensive effect.
Instruct patient to report these symptoms to physician: Shortness of breath, chest pain, confusion, convulsions, impotence.
Advise patient to take sips of water frequently, suck on ice chips or sugarless hard candy or chew sugarless gum to prevent dry mouth or unpleasant tastes.
Instruct patient to avoid intake of alcoholic beverages, sedatives/hypnotics or other CNS depressants.
Advise patient to use caution while driving or performing other tasks requiring mental alertness until effect is determined.