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Trazodone Hydrochloride Uses, Dosage, Side Effects

TRAZODONE HYDROCHLORIDE

(tray′zoe-done)
Oleptro
Classifications: ANTIDEPRESSANT
Therapeutic: ANTIDEPRESSANT
Prototype: Imipramine
Pregnancy Category: C

AVAILABILITY
Tablet; extended release tablet

ACTION & THERAPEUTIC EFFECT
Centrally acting antidepressant that potentiates serotonin effects by se- lectively blocking its reuptake at presynaptic membranes in CNS. Produces varying degrees of seda- tion in normal and mentally de- pressed patients. Increases total sleep time, decreases number and duration of awakenings in de- pressed patient, and decreases REM sleep. Has antianxiety effect in se- verely depressed patient.

USES
Major depressive disorder.

UNLABELED USES
Adjunctive treatment of alcohol dependence, anxiety, panic disorder, insomnia.

CONTRAINDICATIONS
Initial recovery phase of MI; ventricular ectopy; electroshock therapy; with- in 14 days of MAOIs use; suicidal ideation.

CAUTIOUS USE
Bipolar disorder, older adults; history of suicidal tendencies; cardiac arrhythmias or disease; hepatic disease, renal im- pairment; pregnancy (category C), lactation. Safe use in children not established.

ROUTE & DOSAGE
Depression
Adult: PO Immediate release: 150 mg/day in divided doses, may increase by 50 mg/day q3–4days (max: 400–600 mg/ day)
PO Extended release: 150 mg daily may increase by 75 mg/day at 3 day intervals (max: 375 mg/ day)

Pharmacogenetic Dosage Adjustment
Poor CYP2D6 metabolizer: Start with 80% of normal dose

ADMINISTRATION
Oral

Ensure that extended-release tab- lets are swallowed whole. They should not be crushed or chewed.
Give drug with food; increases amount of absorption by 20% and appears to decrease incidence of dizziness or light-headedness. Maintain the same schedule for food-drug intake throughout treat- ment period to prevent variations in serum concentration.
Store in tightly closed, light- resistant container at 15°–30° C (59°–86° F).

ADVERSE EFFECTS (≥1%)
CNS: Dr owsiness, light-headedness, tiredness, dizziness, insomnia, head- ache, agitation, impaired memory and speech, disorientation. CV: Hypotension (including orthostatic hypotension), hypertension, synco- pe, shortness of breath, chest pain, tachycardia, palpitations, brady- cardia, PVCs, ventricular tachycar- dia (short episodes of 3–4 beats). Special Senses: Nasal and sinus congestion, blurred vision, eye ir- ritation, sweating or clamminess, tinnitus. GI: Dry mouth, anorexia, constipation, abdominal distress, nausea, vomiting, dysgeusia, flatu- lence, diarrhea. Urogenital: Hema- turia, increased frequency, delayed urine flow, early or absent menses, male priapism, ejaculation inhibi- tion. Hematologic: Anemia. Muscu- loskeletal: Skeletal aches and pains, muscle twitches. Skin: Skin erup- tions, rash, pruritus, acne, photo- sensitivity. Body as a Whole: Weight gain or loss.

Trazodone Hydrochloride Uses, Dosage, Side Effects

Related for Nursing Implications and Drugs Guide Information

INTERACTIONS
Drug: ANTIHY- PERTENSIVE AGENTS may potentiate hypotensive effects; alcohol and other CNS DEPRESSANTS add to depres- sant effects; may increase digoxin or phenytoin levels; MAO INHIBITORS may precipitate hypertensive crisis; ketoconazole, indinavir, ritona- vir, saquinavir may increase lev- els and toxicity. Use of other sero- tonergic agents may increase risk of serotonin syndrome. Do not use with conivaptan, ivabradine, lin- ezolid, mifepristone, saquinavir. Herbal: Ginkgo may increase seda- tion.

PHARMACOKINETICS
Absorp- tion: Readily from GI tract. Onset: 1–2 wk. Peak: 1–2 h. Distribution: Distributed into breast milk. Metabo- lism: In liver (CYP2D6). Elimina- tion: 75% in urine, 25% in feces. Half-Life: 5–9 h.

NURSING IMPLICATIONS

Black Box Warning
Trazodone hydrochloride has been associated with suicidal thinking and behavior in children, adolescents, and young adults.

Assessment & Drug Effects

Monitor BP and heart rate and rhythm. Report to prescriber de- velopment of tachycardia, brady- cardia, or palpitations.
Monitor for orthostatic hypoten- sion, especially in the elderly or those taking concurrent antihy- pertensive drugs.
Monitor children and adolescents for changes in behavior that indi- cate increased suicidality.
Observe patient’s level of activity. If it appears to be increasing to- ward sleeplessness and agitation with changes in reality orienta- tion, report to prescriber. Manic episodes have been reported.
Be aware that overdose is charac- terized by an extension of com- mon adverse effects: Vomiting, lethargy, drowsiness, and exag- gerated anticholinergic effects.

Patient & Family Education

Report immediately to prescriber signs of worsening mental status such as suicidal ideation, aggres- siveness, agitation, anxiety, hostil- ity, impulsivity, insomnia, irritabil- ity, panic attacks, and worsening of depression.
Consult prescriber if drowsiness becomes a distressing adverse ef- fect. Dose regimen may be changed so that largest dose is at bedtime.
Limit or abstain from alcohol use. The depressant effects of CNS de- pressants and alcohol may be po- tentiated by this drug.
Do not self-medicate with OTC drugs for colds, allergy, or insom- nia treatment without advice of prescriber. Many of these drugs contain CNS depressants.
Male patient should report inap- propriate or prolonged penile erections. The drug may be dis- continued.

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