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  • Trazodone
    (Trazodone HCl) - Various


    Antidepressants increased the risk of suicidal thinking and behavior (suicidality) in children, adolescents, and young adults in short-term studies of major depressive disorder (MDD) and other psychiatric disorders. Monitor and observe closely for clinical worsening, suicidality, or unusual changes in behavior. Not approved for use in pediatric patients.


    Triazolopyridine derivative




    Treatment of MDD in adults.


    Adults: Initial: 150mg/day in divided doses after a meal or light snack. Titrate: May increase by 50mg/day every 3-4 days. Max: (Outpatient) 400mg/day in divided doses. (Inpatient) 600mg/day in divided doses. Once adequate response is achieved, may reduce dose gradually, with subsequent adjustment, depending on therapeutic response. Maint: Generally recommended to continue treatment for several months after an initial response. Maintain on the lowest effective dose and periodically reassess to determine the continued need for maintenance treatment. May administer major portion of daily dose at hs or reduce dose if drowsiness occurs.


    Tab: 50mg*, 100mg*, 150mg*, 300mg* *scored


    Monitor for withdrawal symptoms when discontinuing treatment; gradually reduce dose whenever possible. May cause serotonin syndrome or neuroleptic malignant syndrome (NMS)-like reactions; d/c immediately and initiate supportive symptomatic treatment. May precipitate a mixed/manic episode in patients at risk for bipolar disorder; screen for risk of bipolar disorder prior to initiating treatment. Not approved for treatment of bipolar depression. May cause QT/QTc interval prolongation and torsades de pointes. Not recommended for use during initial recovery phase of myocardial infarction (MI). Caution with cardiac disease; may cause cardiac arrhythmias. Hypotension, including orthostatic hypotension and syncope, reported. May increase risk of bleeding events. Priapism reported; caution in men with conditions that may predispose to priapism (eg, sickle cell anemia, multiple myeloma, leukemia) or with penile anatomical deformation (eg, angulation, cavernosal fibrosis, Peyronie's disease); d/c with erection lasting >6 hrs (painful or not). Hyponatremia may occur; d/c and institute appropriate medical intervention if symptomatic hyponatremia occurs. May cause somnolence or sedation and may impair mental/physical abilities. Caution with hepatic/renal impairment and in elderly.


    Somnolence/sedation, dizziness, constipation, blurred vision, dry mouth, headache, nervousness, N/V, fatigue, abdominal/gastric disorder, nasal/sinus congestion, musculoskeletal aches/pains.


    May cause serotonin syndrome or NMS-like reactions with other serotonergic drugs (eg, SSRIs, SNRIs, triptans), drugs that impair serotonin metabolism (eg, MAOIs), antipsychotics, or other dopamine antagonists; d/c immediately if these occur. Caution with other drugs that may affect the neurotransmitter systems. Not recommended with serotonin precursors (eg, tryptophan). CYP3A4 inhibitors (eg, ritonavir, ketoconazole, indinavir) may increase levels with the potential for adverse effects. Potent CYP3A4 inhibitors may increase risk of cardiac arrhythmia; consider lower dose of trazodone. CYP3A4 inducers (eg, carbamazepine) may decrease levels; monitor to determine if a trazodone dose increase is required. Increased serum digoxin or phenytoin levels reported; monitor serum levels and adjust dosages as needed. Should not be used with an MAOI or within 14 days of discontinuing an MAOI; allow at least 14 days after stopping trazodone before starting an MAOI. May enhance response to alcohol, barbiturates, and other CNS depressants. May alter PT in patients on warfarin. Concomitant use with an antihypertensive may require a dose reduction of the antihypertensive drug. Monitor for potential risk of bleeding and use caution with NSAIDs, aspirin, and other drugs that affect coagulation or bleeding. Increased risk of hyponatremia with diuretics. Increased risk of cardiac arrhythmia with drugs that prolong QT interval.


    Category C, caution in nursing.


    Triazolopyridine derivative; not established. Suspected to be related to its potentiation of serotonergic activity in the CNS. Preclinical studies show selective inhibition of neuronal reuptake of serotonin and activity as an antagonist at 5-HT-2A/2C serotonin receptors.


    Absorption: Well-absorbed; Tmax=1 hr (fasted), 2 hrs (fed). Distribution: Plasma protein binding (89%-95%). Metabolism: Liver (extensive); CYP3A4 via oxidative cleavage; m-chlorophenylpiperazine (active metabolite). Elimination: Urine (<1% unchanged).


    Assess for psychiatric history (including family history of suicide, bipolar disorder, and depression), cardiac disease (eg, recent MI), conditions that may predispose to priapism, penile anatomical deformation, hepatic/renal impairment, pregnancy/nursing status, and possible drug interactions.


    Monitor for signs/symptoms of clinical worsening, suicidality, unusual changes in behavior, serotonin syndrome, NMS-like reactions, QT/QTc interval prolongation, cardiac arrhythmias, hypotension, syncope, bleeding events, priapism, hyponatremia, withdrawal symptoms, and other adverse reactions. Periodically reassess to determine the continued need for maintenance treatment.


    Inform about the benefits and risks of therapy. Instruct patients and caregivers to notify physician if signs of clinical worsening, changes in behavior, or suicidality occur. Inform that withdrawal symptoms (eg, anxiety, agitation, sleep disturbances) may occur. Caution against performing potentially hazardous tasks (eg, operating machinery, driving) until accustomed to effects of medication. Instruct to notify physician if pregnant, intending to become pregnant, or breastfeeding. Instruct men to immediately d/c therapy and seek emergency medical attention if erection lasts >6 hrs, whether painful or not.


    Administration: Oral route. Take shortly after a meal or light snack. Swallow tabs whole or administer as a half tab by breaking the tab along the score line. Storage: 20-25°C (68-77°F); excursions permitted to 15-30°C (59-86°F).