Trazodone: Side Effects, Interactions, and Overdose

What is trazodone and what is it used for?

Trazodone (Desyrel) is an antidepressant that works on chemicals and chemical receptors in our bodies. Trazodone falls under a class of medications known as selective serotonin reuptake inhibitors (SSRIs) and is approved by the United States Food and Drug Administration as a treatment for major depressive disorder. Trazodone works by increasing the amount of serotonin within the brain. The increased levels of serotonin are believed to affect sleep, mood disorders, pain, and other conditions.

Is trazodone a controlled substance? 

Trazodone is not a narcotic or controlled substance. Trazodone is not considered to be an addictive substance when used as prescribed.

What are the side effects of trazodone? 

Common side effects of trazodone use include dry mouth, blurred vision, drowsiness, fatigue, vomiting, and dizziness. Trazodone may cause a decrease in blood pressure, especially in older adults and in people who stand up suddenly.  Standing up slowly from a sitting or recumbent position may lessen this effect. Men who take trazodone may experience painful and prolonged erections. This condition is known as “priapism”, and it requires immediate medical attention to prevent permanent tissue damage from occurring. Less common effects of trazodone can include irregular heartbeats, personality changes, and low blood sodium levels (also called “hyponatremia”). Antidepressants, including trazodone, may increase suicidal thoughts, especially in younger patients, during the first few months of drug therapy, and when a dosage is increased. 

Trazodone Interactions

Taking trazodone with other medications that increase serotonin levels, such as dextromethorphan, tricyclic antidepressants, tryptophan or 5-HTP, and buspirone, can cause a potentially life-threatening condition called “serotonin syndrome”. Trazodone commonly causes drowsiness, which may be increased when taken with other sedating medications. People with underlying heart disease, or those who take medications that affect heart rhythm, are at increased risk of developing irregular heartbeats when taking trazodone.

Can trazodone be taken with alcohol? 

Trazodone may increase the sedating effects of alcohol, and taking trazodone with alcohol can lead to excessive somnolence or confusion. Because of this, it is recommended to avoid drinking alcohol while taking trazodone.

Can I take melatonin with trazodone for sleep?

There are no known interactions between trazodone and melatonin, however taking both together may cause excessive sedation. In addition, melatonin products may contain unwanted contaminants that can interact significantly with trazodone. In one study, 8 out of 31 melatonin supplement products tested contained 5-HTP, a serotonin precursor that was not listed on the product label.  Taking these contaminated melatonin products together with trazodone may increase the risk of serotonin syndrome.

Is it safe to take trazodone during pregnancy?

There are currently no well-controlled published studies of trazodone use by pregnant women, however, some animal studies show an association between trazodone use and fetal harm. Because of this, pregnant women should carefully discuss the risks and benefits of trazodone use with their physicians. The National Pregnancy Registry for Antidepressants (NPRAD) is dedicated to evaluating the safety of antidepressant medications that are taken during pregnancy. Women who take trazodone during pregnancy are encouraged to participate in this study in order to help scientists and doctors learn more about the effects of this drug on fetal outcomes. Learn more about the registry here. 

Are there any symptoms of trazodone withdrawal? 

Symptoms of trazodone withdrawal, including adverse reactions, may occur upon abrupt discontinuation of this drug. To avoid trazodone withdrawal, it is important to gradually reduce the dose of trazodone rather than stopping the drug suddenly. Symptoms of withdrawal may include rapid mood swings, irritability, and anxiety. Since the signs and symptoms of trazodone withdrawal can be very uncomfortable, it is important to gradually decrease the dose of trazodone under the guidance of a physician.

Can you overdose on trazodone? 

Trazodone overdose can occur when a person takes too much trazodone at one time. Signs and symptoms of an overdose may include excessive drowsiness, low blood pressure, fainting, or an irregular heartbeat.

When trazodone is taken with other medications that affect serotonin levels, a severe and sometimes fatal condition called serotonin syndrome may occur. Serotonin syndrome can occur in individuals who take trazodone at the prescribed dose as well as in overdose. Signs and symptoms of serotonin syndrome can include confusion, muscle tremors or stiffness, and changes in blood pressure or heart rate.

What to do if someone takes too much trazodone or takes it by accident 

If someone takes too much trazodone or takes it by mistake, get guidance from Poison Control immediately. Help from Poison Control can be obtained online at www.poison.org or by phone at 1-800-222-1222. Both options are free, confidential, and available 24 hours a day.

Desyrel^® is manufactured by Pragma Pharmaceuticals, LLC and distributed by Fera Pharmaceuticals, LLC.

Micaela E Seazzu, BS
Doctor of Pharmacy Student, Pharmacy Intern at the University of New Mexico