(1)triprolidine and trazodone both increase sedation. Use Caution/Monitor.triptorelinMonitor Closely (1)triptorelin increases toxicity of trazodone by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.tropisetronMonitor Closely (1)trazodone and tropisetron both increase QTc interval. Modify Therapy/Monitor Closely.trospium chlorideMonitor Closely (1)trospium chloride and trazodone both decrease cholinergic effects/transmission. Use Caution/Monitor.tucatinibSerious - Use Alternative (1)tucatinib will increase the level or effect of trazodone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid concomitant use of tucatinib with CYP3A substrates, where minimal concentration changes may lead to serious or life-threatening toxicities. If unavoidable, reduce CYP3A substrate dose according to product labeling.valbenazineMonitor Closely (1)valbenazine and trazodone both increase QTc interval. Use Caution/Monitor.vasopressinMinor (1)trazodone increases effects of vasopressin by pharmacodynamic synergism. Minor/Significance Unknown.vecuroniumMonitor Closely (1)vecuronium and trazodone both decrease cholinergic effects/transmission. Use Caution/Monitor.venlafaxineMonitor Closely (1)trazodone and venlafaxine both increase QTc interval. Modify Therapy/Monitor Closely.Serious - Use Alternative (1)trazodone and venlafaxine both increase serotonin levels. Avoid or Use Alternate Drug.verapamilMonitor Closely (1)verapamil will increase the level or effect of trazodone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.Minor (1)verapamil increases levels of trazodone by decreasing metabolism. Minor/Significance Unknown.vilazodoneSerious - Use Alternative (1)trazodone, vilazodone. Either increases toxicity of the other by serotonin levels. Avoid or Use Alternate Drug. Concomitant therapy should be discontinued immediately if signs or symptoms of serotonin syndrome emerge and supportive symptomatic treatment should be initiated.vildagliptinMinor (1)trazodone increases effects of vildagliptin by pharmacodynamic synergism. Minor/Significance Unknown.vinblastineMonitor Closely (1)trazodone will decrease the level or effect of vinblastine by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.vincristineMonitor Closely (1)trazodone will decrease the level or effect of vincristine by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.vincristine liposomalMonitor Closely (1)trazodone will decrease the level or effect of vincristine liposomal by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.voriconazoleMonitor Closely (1)trazodone and voriconazole both increase QTc interval. Modify Therapy/Monitor Closely.Serious - Use Alternative (1)voriconazole will increase the level or effect of trazodone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.vorinostatSerious - Use Alternative (1)vorinostat and trazodone both increase QTc interval. Avoid or Use Alternate Drug.vortioxetineSerious - Use Alternative (1)trazodone increases toxicity of vortioxetine by serotonin levels. Avoid or Use Alternate Drug.voxelotorSerious - Use Alternative (1)voxelotor will increase the level or effect of trazodone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Voxelotor increases systemic exposure of sensitive CYP3A4 substrates. Avoid coadministration with sensitive CYP3A4 substrates with a narrow therapeutic index. Consider dose reduction of the sensitive CYP3A4 substrate(s) if unable to avoid.xylometazolineMonitor Closely (1)trazodone increases and xylometazoline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)trazodone, xylometazoline. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.yohimbeSerious - Use Alternative (1)yohimbe, trazodone. Mechanism: unspecified interaction mechanism. Contraindicated. May cause increase or decrease in blood pressure.yohimbineMonitor Closely (1)trazodone increases and yohimbine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.Serious - Use Alternative (1)trazodone, yohimbine. Other (see comment). Avoid or Use Alternate Drug. Comment: Tricyclic antidepressants increase or decrease effects of sympathomimetics, by blocking reuptake of NE, or blocking uptake of indirect sympathomimetics into the adrenergic neuron.zafirlukastMinor (1)zafirlukast will increase the level or effect of trazodone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.ziconotideMonitor Closely (1)trazodone and ziconotide both increase sedation. Use Caution/Monitor.ziprasidoneMonitor Closely (1)ziprasidone and trazodone both increase sedation. Use Caution/Monitor.Serious - Use Alternative (1)trazodone and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.zolmitriptanMonitor Closely (1)zolmitriptan and trazodone both increase serotonin levels. Modify Therapy/Monitor Closely.Minor (1)trazodone, zolmitriptan. Mechanism: unknown. Minor/Significance Unknown. Risk of weakness, dyspnea, chest pain.zolpidemMinor (1)zolpidem, trazodone. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive CNS depression. >10% Blurred vision (5-15%) Dizziness (20-28%) Drowsiness (24-40%) Dry mouth (15-34%) Fatigue (6-15%) Headache (10-33%) Nausea/vomiting (10-21%) 1-10% Constipation (7-8%) Edema (3-7%) Confusion (5-6%) Disorientation (<2%) Incoordination (2-5%) Nasal congestion (3-6%) Orthostatic hypotension (<7%) Syncope (<5%) Tremor (1-5%) Weight change (5%) Ejaculation disorder (2%) Decreased libido (1-2%) <1% Priapism Sedation Alopecia Anxiety Acne Anemia Increased apetite Diplopia Insomnia Urinary retention Vertigo Black Box Warnings In short-term studies, antidepressants increased the risk of suicidal thinking and behavior in children, adolescents, and young adults (<24 yr of age) taking antidepressants for major depressive disorders and other psychiatric illnesses This increase was not seen in patients aged >24 years; a slight decrease in suicidal thinking was seen in adults >65 years In children and young adults, risks must be weighed against the benefits of taking antidepressants Patients should be monitored closely for changes in behavior, clinical worsening, and suicidal tendencies; this should be done during initial 1-2 months of therapy and dosage adjustments The patient’s family should communicate any abrupt changes in behavior to the healthcare provider Worsening behavior and suicidal tendencies that are not part of the presenting symptoms may require discontinuation of therapy This drug is not FDA approved for use in pediatric patients or for treatment of bipolar depressionContraindications Hypersensitivity Coadministration with serotonergic drugs Risk of serotonin syndrome when coadministered within 14 days of MAOIs, or coadministered with other strong serotonergic drugs (eg, SNRIs, SSRIs) Starting trazodone in a patient who is being treated with linezolid or IV methylene blue is contraindicated because of an increased risk of serotonin syndrome If linezolid or IV methylene blue must be administered, discontinue trazodone immediately and monitor for CNS toxicity; may resume clomipramine 24 hr after last linezolid or methylene blue dose or after 2 weeks of monitoring, whichever comes first Cautions Administer shortly after meal; if drowsiness occurs, decrease dosage or give most of divided dosage HS Discontinue if prolonged or inappropriate erection occurs Discontinue if neutropenia, leukopenia Use caution in patients with risk of seizures Clinical worsening and suicide ideation may occur despite medication in adolescents and young adults (18-24 years) Perform leukocyte and differential with fever, sore throat, or other signs of infection Discontinue if leukocytes/ANC decreases below normal range Coadministration with MAO inhibitors: risk of serotonin syndrome Drugs that interfere with serotonin reuptake have been associated with bleeding; trazodone may also impair platelet aggregation resulting in increased risk of bleeding events Potentially life-threatening serotonin syndrome reported when coadministered with drugs that impair serotonin metabolism (in particular, MAOIs, including nonpsychiatric MAOIs, such as linezolid and IV methylene blue) (see Contraindications) Coadministration with NSAIDs and aspirin, may increase risk of bleeding Bone fractures associated with antidepressant treatments Increases risk of hyponatremia Use caution in patients with risk of seizures including head trauma, alcoholism, brain damage May worsen psychosis in patients or precipitate mania or hypomania; screen, for bipolar disorder, patients presenting with depressive symptoms May cause orthostatic hypotension and syncope; use wiht caution QT prolongation with or without torsade de pointes and ventricular tachycardia reported May increase risk associated with electroconvulsive therapy (ECT); discontinue ECT before initiating trazodone therapy Risk of mydriasis; may trigger angle closure attack in patients with angle closure glaucoma with anatomically narrow angles without a patent iridectomy Pregnancy Published prospective cohort studies, case series, and case reports over several decades with use in pregnant women have not identified drug-associated risks of major birth defects, miscarriage, or adverse maternal or fetal outcomes Drug has been shown to cause increased fetal resorption and other adverse effects on fetus in rat when given at dose levels approximately 7.3 to 11 times the maximum recommended human dose (MRHD) of 400 mg/day in adults on a mg/m² basis; there was also an increase in congenital anomalies in the rabbit at approximately 7.3 to 22 times the MRHD on a mg/m² basis Consider the risk of untreated depression when discontinuing or changing treatment with antidepressant medication during pregnancy and postpartum Lactation Data from published literature report the transfer of trazodone into human milk; there are no data on effect on milk production; limited data from postmarketing reports have not identified an association of adverse effects on breastfed child The developmental and health benefits of breastfeeding should be considered along with mother’s clinical need for therapy and any potential adverse effects on breastfed child or from underlying maternal conditionPregnancy Categories A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk. B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk. C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done. D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk. X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist. NA: Information not available. Mechanism of Action Antidepressant structurally unrelated to SSRIs, tricyclics, tetracyclics or MAOIs, but also inhibits neuronal uptake of serotonin (but not NE); it is a histamine and alpha1-adrenergic receptor antagonist; causes adrenoceptor subsensitivity Absorption Almost completely absorbed (increased by food) Onset: 6 weeks (antidepressant); 1-3 hr sleep aid Peak serum time: 30-100 min (up to 2.5 hr if taken with food); 9 hr (extended release) Concentration: 480-1620 ng/mL (dose-dependent) Distribution Protein bound: 85-95% Metabolism Metabolism: hepatic P450 enzyme CYP3A4 (major) CYP2D6 (minor) Metabolites: l-m-chlorophenylpiperazine Elimination Half-life: 7-10 hr Excretion: Urine (75%); feces (25%) Dialyzable: No Oral Administration Take with food BRAND FORM. UNIT PRICE PILL IMAGE trazodone oral- 100 mg tablettrazodone oral- 150 mg tablettrazodone oral- 50 mg tablettrazodone oral- 150 mg tablettrazodone oral- 50 mg tablettrazodone oral- 150 mg tablettrazodone oral- 100 mg tablettrazodone oral- 50 mg tablettrazodone oral- 50 mg tablettrazodone oral- 100 mg tablettrazodone oral- 100 mg tablettrazodone oral- 150 mg tablettrazodone oral- 50 mg tablettrazodone oral- 300 mg tablettrazodone oral- 300 mg tablettrazodone oral- 100 mg tablettrazodone oral- 50 mg tablettrazodone oral- 100 mg tablettrazodone oral- 150 mg tablettrazodone oral- 150 mg tablettrazodone oral- 300 mg tablettrazodone oral- 300 mg tablettrazodone oral- 300 mg tablettrazodone oral- 300 mg tabletCopyright © 2010 First DataBank, Inc.Print Patient Educationtrazodone oral TRAZODONE - ORAL (TRAZ-oh-done) COMMON BRAND NAME(S): Desyrel WARNING: Antidepressant medications are used to treat a variety of conditions, including depression and other mental/mood disorders. These medications can help prevent suicidal thoughts/attempts and provide other important benefits. However, studies have shown that a small number of people (especially people younger than 25) who take antidepressants for any condition may experience worsening depression, other mental/mood symptoms, or suicidal thoughts/attempts. It is very important to talk with the doctor about the risks and benefits of antidepressant medication (especially for people younger than 25), even if treatment is not for a mental/mood condition.Tell the doctor right away if you notice worsening depression/other psychiatric conditions, unusual behavior changes (including possible suicidal thoughts/attempts), or other mental/mood changes (including new/worsening anxiety, panic attacks, trouble sleeping, irritability, hostile/angry feelings, impulsive actions, severe restlessness, very rapid speech). Be especially watchful for these symptoms when a new antidepressant is started or when the dose is changed. USES: This medication is used to treat depression. It may help to improve your mood, appetite, and energy level as well as decrease anxiety and insomnia related to depression. Trazodone works by helping to restore the balance of a certain natural chemical (serotonin) in the brain. HOW TO USE: Read the Medication Guide provided by your pharmacist before you start using trazodone and each time you get a refill. If you have any questions, consult your doctor or pharmacist.Take this medication by mouth after a meal or snack as directed by your doctor, usually once or twice daily. If drowsiness is a problem and you are taking 1 dose daily, take it at bedtime. If you are taking 2 doses each day, it may help to take 1 of the doses at bedtime. Follow your doctor's directions carefully.Dosage is based on your medical condition and response to treatment. To reduce your risk of side effects, your doctor may start you at a low dose and gradually increase your dose.Take this medication exactly as prescribed. Do not increase your dose or take this medication more often than prescribed. Your condition will not improve any faster, and the risk of serious side effects may be increased.Keep taking this medication as prescribed even if you feel well. To help you remember, take it at the same time(s) each day. Do not stop taking this medication