- 1 How long does it take for trazodone to wear off?
- 2 Does trazodone make you feel bad the next day?
- 3 Is 50 mg of trazodone a lot for sleep?
- 4 Why do I feel weird after taking trazodone?
- 5 Is 50 mg trazodone enough for anxiety?
- 6 Can you build a tolerance to trazodone for sleep?
- 7 Is 25 mg of trazodone enough for sleep?
- 8 Is trazodone bad for your memory?
- 9 Does trazodone make you gain weight?
- 10 How do you reverse the effects of trazodone?
- 11 Is trazodone a strong sleeping pill?
How long does it take for trazodone to wear off?
How Long Does It Take Trazodone To Wear Off? Trazodone has a half-life of around 5 to 9 hours. This means that it can take 5 to 9 hours for your body to eliminate half of the drug.
How many hours does trazodone 50 mg last?
Frequently Asked Questions –
How does trazodone treat insomnia? Trazadone works to promote sleep in a few different ways. It is an antidepressant that makes people tired. It increases serotonin levels to improve your mood and acts as an antihistamine similar to Benadryl, making you drowsy. Is trazodone a sleep medicine? Not officially, but it is often prescribed off-label to treat insomnia. An older-generation antidepressant, trazodone was FDA-approved for treating anxiety and depression in 1981. Drowsiness is a side-effect of trazodone. When prescribed as an antidepressant, it should be taken at bedtime. How long does it take for trazodone to kick in for sleep? Trazodone works rather quickly as a sleep aid and typically takes about 30 minutes to make you drowsy. Most people who take trazodone for sleep find it helps them to both fall asleep and stay asleep throughout the night. Will trazodone make me drowsy in the morning? It may, especially when you first start taking it or if you take it too late at night. Depending on the individual, the sleep-promoting effects of trazodone can last between five to nine hours. You should not drive or operate heavy machinery until you know how trazodone affects you.
Does trazodone make you feel bad the next day?
What are the side effects of trazodone? – Trazodone usage can cause a decrease in sodium levels in the body, a disruption of the nervous system or serotonin syndrome. The most common side effects include:
Drowsiness (including feeling groggy the next day) Dizziness (including an increased risk of fainting/falling) Dry mouth Constipation Headache Fatigue Tingling or numbness in hands, arms or legs Blurred vision Disorientation Vertigo Nasal congestion Shaking Anxiety Muscle aches Prolonged and painful erections lasting longer than six hours (priapism) Abnormally low blood pressure Heart rhythm disorders Increased risk of suicidal thoughts and behavior in children and adolescents (even when taken at approved doses for depression) Acting on dangerous impulses Insomnia (at high doses) Weight gain or loss
The drug can stay in a person’s system for 42 hours after the final dose. Higher doses can produce more severe side effects.
Do I need to taper off 50mg of trazodone?
3. Downsides – If you are between the ages of 18 and 60, take no other medication or have no other medical conditions, side effects you are more likely to experience include:
Dry mouth, headache, constipation, diarrhea, and sexual dysfunction. Trazodone may cause a discontinuation syndrome if abruptly stopped, symptoms include anxiety, agitation, and sleep disturbances. When the time comes to withdraw trazodone, the dosage should be tapered off slowly under a doctor’s advice. May increase the risk of suicidal thoughts or behavior in young adults, children, and teenagers within the first months of treatment (similar to other antidepressants). May cause drowsiness or dizziness and affect a person’s ability to drive or operate machinery. Alcohol should be avoided. Hyponatremia and low blood pressure (particularly when going from a sitting to a standing position) may occur. Rarely, may cause ECG changes in the heart (particularly in those with pre-existing cardiac disease) and priapism (painful erections lasting more than 6 hours in duration). May precipitate a manic episode in people with undiagnosed bipolar disorder. Interaction or overdosage may cause serotonin syndrome (symptoms include mental status changes ), fast heart rate, dizziness, flushing, muscle tremor or rigidity, and stomach symptoms (including nausea, vomiting, and diarrhea). May increase the risk of bleeding, especially if used with other drugs that also increase bleeding risk. May trigger an angle-closure attack in certain people at risk of this type of glaucoma. May cause a lowering of total body sodium (called hyponatremia); elderly people or people taking diuretics or already dehydrated may be more at risk. Rarely causes seizures.
Note: In general, seniors or children, people with certain medical conditions (such as liver or kidney problems, heart disease, diabetes, seizures) or people who take other medications are more at risk of developing a wider range of side effects. View complete list of side effects
Does trazodone cause brain fog?
Trazodone for sleep reduces worsening of memory Memory loss due to dementia. Senior man losing parts of head as symbol of decreased mind function. Trazodone for sleep reduces worsening of memory in patients with and without cognitive impairment. Trazodone has long been my preferred medicine for patients with chronic insomnia.
- I also use it frequently for sleep apnea patients who are not tolerating Continuous Positive Airway Pressure (CPAP) treatment.
- CPAP causes arousals and awakenings and disturbs sleep, and APAP (auto-titrating positive airway pressure) is even worse in this respect.
- Trazodone reduces arousals in sleep apnea patients.
Medicines like trazodone improves CPAP adherence in sleep apnea patients having trouble tolerating CPAP. Researchers from University of California, San Francisco, looked at patients with sleep disorders using trazodone. Some of them had mild cognitive impairment (MCI) or Alzheimer’s dementia (AD).
Others had normal cognition. The researchers compared them with matched patients not using trazodone. Patients on trazodone had less decline in cognitive function over the next few years. Research has shown that trazodone improves sleep in AD patients. Melatonin, ramelteon, and mirtazapine do not. Trazodone does not generally cause cognitive impairment or daytime sleepiness.
This is unlike many other medicines used for sleep. Trazodone has also been shown to increase deep sleep. Other research shows that worse sleep is associated with brain changes also seen in AD, and with worse cognitive function and dementia. Trazodone is an old and very inexpensive medicine.
Despite its benefits and advantages, many opinion makers in the sleep medicine community do not recommend it. The FDA has not approved it for insomnia. To get FDA approval, a pharmaceutical company does large double-blind studies comparing it with placebo (or with another FDA approved medicine). Along the way, the pharmaceutical company involves opinion makers as consultants, speakers, and board members.
If the medicines gets FDA approval for the specific use, opinion makers add their voice. Trazodone is an old generic medicine approved for use in depression (in larger doses than often used for insomnia). It turns out that it is not a particularly effective antidepressant.
Its patents have long expired. Therefore, it is unlikely that any pharmaceutical company will invest in the studies necessary for FDA approval for insomnia, or in convincing opinion makers. As a result, trazodone may never become widely recommended for sleep. In conclusion, trazodone may be helpful in reducing the risk of mild cognitive impairment and Alzheimer’s dementia.
This further strengthens my preference for using trazodone for chronic insomnia. Trazodone also helps towards improving my patients’ CPAP adherence to 85-90% (compared to the national average of 59%). Thus, I also help prevent cognitive decline that occurs in untreated sleep apnea.
Is 50 mg of trazodone a lot for sleep?
Trazodone for sleep – A common side effect of taking trazodone is feeling sleepy or tired.3 This side effect is what highlighted the potential for trazodone to be used as a sleep aid. When used to help people sleep, the dosage of trazodone prescribed differs from other use cases.
For depression, it’s usually given at a starting dose of 150mg/day and for anxiety, it’s generally given at 75mg/day. Depending on what trazodone is being used to treat, the dose range can be anywhere between 75-600mg/day. When it’s given as a sleep aid, it’s given at the lower end of the dose range, generally between 50-100mg/day.
At these doses, it’s thought that trazodone can induce sleepiness that is enough to help people to sleep, but the effects don’t last long enough to affect the person when they wake.3 We’ve already explained how trazodone can change serotonin levels in the brain, but it also affects the levels of other chemicals that are associated with wakefulness.
Is 50 mg of trazodone high?
Trazodone overdose – There have been reports of overdose with trazodone use. These risks are higher with drinking alcohol, taking benzodiazepines, and other central nervous system depressant drugs that can slow your breathing and reactions. Drug overdose can be fatal.
drowsinessseizuresvomitingheart rhythm changesrespiratory arrest (stop breathing)
Trazodone is an older medication approved for use by the FDA in 1981 as an antidepressant. Although trazodone use for sleep is common, according to recent guidelines published by the American Academy of Sleep Medicine, trazodone should not be the first line of treatment for insomnia.
Will trazodone work the first night?
Will Trazodone Help Immediately? – Trazodone is an antidepressant and a commonly used sleep medicine that does not work immediately for everyone. It may take a while to experience the full impact. For some, that can be as long as 4 – 6 weeks. Others, though, might start feeling the benefits of this medication in just a day or 2.
What is the biggest side effect of trazodone?
The bottom line Common trazodone side effects include drowsiness, dry mouth, and dizziness. More serious side effects include priapism, suicidal thoughts, and serotonin syndrome. Be sure to discuss any side effect concerns you may have with your healthcare provider.
Why do I feel weird after taking trazodone?
If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.
- Depression isn’t just feeling sad or down.
- This mood disorder can affect all aspects of life, including your appetite, weight, sleep, work, and relationships ( NIMH, 2018 ).
- Although we don’t yet know exactly how depression works, we do know it has to do with the balance of certain chemicals in the brain ( Chand, 2020 ).
Prescription medications like trazodone may help by affecting the levels of these chemicals. Still, you may worry about the potential side effects of these prescription drugs. If you’re talking to your healthcare provider about trazodone, here’s what you need to know.
The most common side effects of trazodone are drowsiness, nausea, dizziness, and dry mouth ( Zhang, 2014 ). Trazodone is generally well tolerated and may be less likely than some other antidepressants to cause insomnia, sexual side effects, and anxiety ( Shin, 2020 ). Clinical trials have also reported other side effects, including blurry vision, constipation, confusion, fatigue, nervousness, tremors, and weight changes ( FDA, 2017 ).
You may be more likely to experience side effects if you’re taking certain medications with trazodone. For example, there are drugs that can impact a system in your liver called CYP3A4, which breaks down trazodone (Shin, 2020). These medications may slow down this system, resulting in a buildup of trazodone in your body.
- In other words: increased levels of trazodone means an increased risk of potential side effects ( NIH, 2017 ).
- While not as common, trazodone does have the potential for serious side effects.
- The drug can cause serotonin levels in the body to become too high, leading to a condition called serotonin syndrome,
Normally, chemical messengers (also known as neurotransmitters) pass messages between cells in the brain. Serotonin is one type of neurotransmitter. Researchers suggest medications like trazodone help alleviate depression by maintaining high levels of serotonin in the brain.
However, abnormally high serotonin levels can cause adverse effects ranging from mild to life-threatening ( Volpi-Abadie, 2013 ). Symptoms of serotonin syndrome include agitation, anxiety, disorientation, flushed skin, increased heart rate, nausea, restlessness, sweating, tremor, and vomiting. Shaking is particularly common ( Simon, 2020 ).
Trazodone may also cause fainting, irregular heartbeat, chest pain, seizures, shortness of breath, or difficulty breathing (NIH, 2017). Contact a healthcare provider immediately if you experience any of these symptoms. Because the side effects of trazodone are dose-dependent, you have a higher chance of experiencing adverse effects with higher doses ( Jaffer, 2017 ).
Why does trazodone make me feel good?
It’s used to treat depression, anxiety, or a combination of depression and anxiety. Trazodone works by increasing your levels of serotonin and noradrenaline so you feel better.
Is 50 mg trazodone enough for anxiety?
Dosage and strength – Trazodone tablets come as 50mg, 100mg and 150mg strengths. Capsules come as 50mg and 100mg strengths. The liquid has either 10mg or 20mg of trazodone in every 1ml. For depression, the usual dose is 150mg daily. But in some cases your doctor may start you on a lower dose of 100mg to reduce the chance of side effects.
Can you build a tolerance to trazodone for sleep?
Tolerance – Over time, individuals addicted to trazodone may develop a tolerance to the drug. This means they need higher medication doses to achieve the same effects.
Is 25 mg of trazodone enough for sleep?
PHARMACOLOGY OF TRAZODONE – Trazodone is a triazolopyridine derivative that was approved in 1982 for the treatment of depression. It belongs to the class of serotonin antagonist and reuptake inhibitors (SARI). Trazodone behaves as an antagonist at the serotonin type 2 (5-HT2) receptors, an antagonist at the alpha1 (α1) adrenergic receptors, and as an inhibitor of serotonin reuptake transporter (SERT).
Of note, another consistent finding in the literature is that trazodone moderates cortisol suppression of the hypothalamic-pituitary-adrenal axis, which likely contributes to the efficacy of trazodone for insomnia. In addition, trazodone has moderate antihistamine and low anticholinergic activity.11 Although its mechanism of action is not fully understood, the main pharmacological action of trazodone is blockade of the serotonin 5-HT2A receptor (1mg of trazodone roughly blocked half of brain 5-HT2A receptors).
Increasing trazodone dose (50mg) causes antagonism on histamine H1 and α1-adrenergic receptors. The blocking of the 5-HT2A, histamine H1, and alpha receptors is thought to produce the hypnotic effect reported for low doses of trazodone (25–100mg).11 At these low doses, trazodone induces and maintains sleep without causing daytime drowsiness or tolerance, mainly because of its short half-life (3–6 hours).11 – 13 For the medication’s antidepressant effects to reach efficacy, simultaneous blocking of 5-HT2A and SERT is required, which occurs at higher doses (150–600mg).11 Tolerance can occur during the combined antagonism actions of 5-HT2A and SERT.11
Does trazodone affect personality?
How does trazodone work? Serotonin and noradrenaline are chemicals in the brain that help improve your mood. When your levels of these chemicals are low, you can get depressed. Trazodone helps increase your levels of serotonin and noradrenaline so you feel better.
How will it make me feel? In the first few days, trazodone may make you feel sleepy. Antidepressants like trazodone help to improve your mood so you feel better. You may notice that you sleep better and get on with people more easily because you’re less anxious. You’ll hopefully be more relaxed about things that used to worry you.
Trazodone will not change your personality, it will simply help you feel like yourself again. When will I feel better? Do not expect to feel better overnight. Trazodone can take 1 to 2 weeks to start to work, and it can be 4 to 6 weeks before you feel the full benefit.
Give the medicine at least 6 weeks to work. Some people feel worse during the first few weeks of treatment before they begin to feel better. During this time, some people occasionally have thoughts of harming themselves or ending their lives. If this happens to you, it’s very important to get help immediately – call 999 or go to A&E,
If you need more help, you can also contact the Samaritans, Are there any long-term side effects? Trazodone is safe to take for a long time. There do not seem to be any lasting harmful effects from taking it for many months, or even years. Some people need to take trazodone long term to treat depression or anxiety that keeps coming back.
If you need it and do not get side effects, there’s no reason to worry about taking trazodone for a long time. Is trazodone addictive? There’s no evidence that trazodone is addictive. But you may get withdrawal side effects if you stop taking it suddenly. This can cause sleep problems, leave you feeling irritable and you may sweat more than usual.
To prevent any withdrawal side effects, talk to your doctor about the best way to come off trazodone. They’ll explain how to reduce your dose gradually. How does trazodone compare with other antidepressants? Trazodone is not usually the first choice of antidepressant,
Doctors usually prescribe it when other antidepressants have not worked or have caused side effects. Trazodone is no better or worse than other antidepressants. Some people respond better to one antidepressant than another. Trazodone is less suitable for elderly people, who may get more side effects. Your doctor will recommend an antidepressant for you based on any other health issues you have and the medicines you have tried already.
You may find trazodone helpful if you have anxiety and problems getting to sleep, or if you’re irritable and agitated. If you are not feeling any better after 6 weeks, talk to your doctor. Are there other treatments that can help depression or anxiety? Antidepressants, including trazodone, are just one of several approaches to treating depression or anxiety,
talking therapy (such as cognitive behavioural therapy )exercise programmes
Other potential treatments for anxiety include:
talking therapy (such as cognitive behavioural therapy )joining a self-help groupusing relaxation techniques
Choosing a treatment that’s most suitable for you depends on:
how long you have had depression or anxietyyour symptomswhether you have had depression or anxiety beforewhether previous treatment workedhow likely you are to stick with your treatmentthe potential side effectsyour preferences and priorities
If you’re interested in any of these treatments, talk to your doctor. Will my doctor prescribe trazodone to help me sleep? Trazodone may make you sleepy. Because of this, it may be a suitable medicine if you have anxiety and difficulty sleeping ( insomnia ).
- But your doctor will not prescribe it just to help you sleep.
- It has not been officially approved for this.
- Can trazodone protect me against dementia? At the moment, there’s no evidence that trazodone protects against dementia,
- But it’s sometimes used to treat some symptoms of dementia, like irritability and agitation.
There are steps you can take that may reduce your risk of dementia, If you’re worried about getting dementia or Alzheimer’s disease, or have a family history of these conditions, speak to your doctor. Will I gain or lose weight? Trazodone can make you feel more or less hungry than usual, so you may lose or gain weight when you start taking it.
If you start to have problems with your weight while taking trazodone, talk to your doctor or pharmacist. Will it affect my contraception? Trazodone does not affect any type of contraception, including the combined pill or emergency contraception, Will it affect my sex life? Trazodone can cause problems with ejaculation.
Some people say it gives them a higher sex drive, others say it makes it lower. Rarely, men may get a painful erection that lasts a long time that is not to do with sexual activity. If you have a long-lasting and painful erection that lasts longer than 2 hours, go to A&E straight away.
Can I drive or ride a bike? Trazodone may make you feel sleepy or less alert. Do not drive, cycle, or use tools or machinery until you know how this medicine affects you. It’s an offence to drive a car if your ability to drive safely is affected. It’s your responsibility to decide if it’s safe to drive.
If you’re in any doubt, do not drive. Talk to your doctor or pharmacist if you’re unsure whether it’s safe for you to drive while taking trazodone. GOV.UK has more information on the law on drugs and driving, Can I drink alcohol with it? You can drink alcohol while taking trazodone, but it may make you feel sleepy.
It might be best to stop drinking alcohol until you see how the medicine makes you feel. Is there any food or drink I need to avoid? You can eat and drink normally while taking trazodone. However, it’s a good idea to stop drinking alcohol until you see how the medicine makes you feel. Will recreational drugs affect it? Cannabis with trazodone can give you a fast heartbeat.
Cannabis can also make drowsiness worse with trazodone, especially in people who have just started taking it. Find out more about the side effects of some recreational drugs on the Frank website, Page last reviewed: 9 March 2022 Next review due: 9 March 2025
Is trazodone bad for your memory?
Long-Term Side Effects of Trazodone Use – While trazodone is generally safe and effective when used as directed for its intended purpose, someone who misuses trazodone for extended periods of time may be at risk of experiencing more intense side effects.
Short-term memory dysfunctions. Verbal learning issues. Equilibrium disruption. Next-day memory performance problems. Difficulties with arm muscle endurance.
Long-term prescription use carries its own set of risks that may be outweighed by the benefits; however, if you are abusing the drug, you may be placing yourself at greater risk and an increased risk of overdose.
What should I avoid while taking trazodone?
Precautions – It is very important that your doctor check your progress at regular visits, to allow for changes in your dose and to help manage any unwanted effects. Do not take trazodone with a monoamine oxidase (MAO) inhibitor (eg, isocarboxazid, linezolid (Zyvox®), methylene blue, phenelzine, selegiline, tranylcypromine ).
Do not start taking trazodone during the 2 weeks after you stop a MAO inhibitor and wait 2 weeks after stopping trazodone before you start taking a MAO inhibitor. If you take them together or do not wait 2 weeks, you may develop confusion, agitation, restlessness, stomach or intestinal symptoms, a sudden high body temperature, an extremely high blood pressure, or severe convulsions.
Trazodone may cause a serious condition called serotonin syndrome if taken together with some medicines. Do not use trazodone with buspirone (Buspar®), fentanyl (Abstral®, Duragesic®), lithium (Eskalith®, Lithobid®), tryptophan, St. John’s wort, or some pain or migraine medicines (eg, sumatriptan, tramadol, Frova®, Maxalt®, Relpax®, Zomig®).
- For some teenagers and young adults, this medicine can increase thoughts of suicide.
- Tell your doctor right away if you start to feel more depressed or have thoughts about hurting yourself or others.
- Report any unusual thoughts or behaviors that trouble you, especially if they are new or get worse quickly.
Make sure the doctor knows if you have trouble sleeping, get upset easily, have a big increase in energy, or start to act reckless. Also tell the doctor if you have sudden or strong feelings, such as feeling nervous, angry, restless, violent, or scared.
- Let the doctor know if you or anyone in your family have bipolar disorder (manic-depressive disorder) or have tried to commit suicide.
- Check with your doctor right away if you have anxiety, restlessness, a fast heartbeat, fever, sweating, muscle spasms, twitching, nausea, vomiting, diarrhea, or see or hear things that are not there.
These may be symptoms of serious conditions called serotonin syndrome and neuroleptic malignant syndrome-like reactions. Your risk may be higher if you also take certain other medicines that affect serotonin levels in your body. Contact your doctor right away if you have any changes in your heart rhythm such as feeling dizzy or faint, or having a fast, pounding, or uneven heartbeat.
- These could be symptoms of a heart problem called QT prolongation.
- Dizziness, lightheadedness, or fainting may occur, especially when you get up suddenly from a lying or sitting position.
- Getting up slowly may help.
- If this problem continues or gets worse, check with your doctor.
- Do not stop taking this medicine without first checking with your doctor.
Your doctor may want you to gradually reduce the amount you are using before stopping it completely. This may help prevent a worsening of your condition and reduce the possibility of withdrawal symptoms such as anxiety, irritability, restlessness, or trouble sleeping.
This medicine may cause some people to become drowsy or less alert than they are normally. Make sure you know how you react to this medicine before you drive, use machines, or do anything else that could be dangerous if you are not alert. This medicine will add to the effects of alcohol and other CNS depressants (medicines that make you drowsy or less alert).
Some examples of CNS depressants are antihistamines or medicine for allergies or colds, sedatives, tranquilizers or sleeping medicine, prescription pain medicine or narcotics, medicine for seizures or barbiturates, muscle relaxants, or anesthetics, including some dental anesthetics.
- Check with your doctor before taking any of the above while you are using this medicine.
- Before having any kind of surgery, dental treatment, or emergency treatment, tell the medical doctor or dentist in charge that you are using this medicine.
- Taking trazodone together with anesthetic medicines (numbing medicines) that are used during surgery, dental treatments, or emergency treatments may cause an increase in CNS depressant effects.
Trazodone may cause dry mouth. For temporary relief, use sugarless gum or candy, melt bits of ice in your mouth, or use a saliva substitute. However, if your mouth continues to feel dry for more than 2 weeks, check with your medical doctor or dentist. Continuing dryness of the mouth may increase the chance of dental disease, including tooth decay, gum disease, and fungus infections.
When is the best time to take trazodone 50 mg?
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.
Does trazodone make you gain weight?
Does trazodone cause weight gain? Trazodone may cause weight gain for some people, but it is not a common side effect of the medication. Weight loss was shown to be slightly more common with trazodone. Research on the drug suggests that the relationship between trazodone and weight change is mixed.
While both weight gain and weight loss side effects are relatively rare compared to its other side effects, trazodone may be more likely to cause weight loss than weight gain. In a clinical trial, 5% of people who took trazodone gained weight, while 6% lost weight. You may notice an increase or decrease in your appetite during treatment with trazodone, a side effect that may be managed with the help of your doctor.
Trazodone is one of many medications used to treat depression. Other antidepressants are more highly associated with weight gain than trazodone. While the reasons why antidepressants may affect weight are poorly understood, there are many connections between the regulation of mood, appetite and weight.
Swelling (edema) Blurry vision Fainting Fatigue and sleepiness Diarrhea Stuffy nose (sinus congestion)
: Does trazodone cause weight gain?
Does grogginess from trazodone go away?
Yes, you do feel groggy in the morning when you first start taking it, but it goes away with time, so don’t give up too soon when you start it because of grogginess.
How long do you have to wait to go to bed after taking trazodone?
Trazodone is an antidepressant medication. It’s FDA approved to treat depression, but it’s more often used off-label for insomnia. When taken 30 minutes before bedtime, a low dose of trazodone (between 25 mg and 100 mg) may be effective for sleep problems.
How do you reverse the effects of trazodone?
Arrhythmias in Severe Trazodone Overdose 1 Department of Medical Education, Dignity Health St. Mary Medical Center, Long Beach, CA, U.S.A. Find articles by 2 Section of Cardiology, Department of Internal Medicine, Dignity Health St. Mary Medical Center, Long Beach, CA, U.S.A.3 Department of Cardiology and Electrophysiology, Long Beach Memorial Medical Center, Long Beach, CA, U.S.A.
- Authors’ Contribution:
- A Study Design
- B Data Collection
- C Statistical Analysis
- D Data Interpretation
- E Manuscript Preparation
- F Literature Search
- G Funds Collection
- Conflict of interest: None declared
Corresponding Author: Kyaw Khaing Soe, e-mail: Received 2019 Sep 2; Accepted 2019 Oct 16. © Am J Case Rep, 2019 This work is licensed under Creative Common Attribution-NonCommercial-NoDerivatives 4.0 International ()
- Patient: Female, 55-year-old
- Final Diagnosis: Trazodone overdose
- Symptoms: Altered mental status • seizure • shock • arrhythmia
- Medication: —
- Clinical Procedure: —
- Specialty: Toxicology
Trazodone is widely used in the treatment of depression, anxiety, and insomnia. It is thought to have a safe cardiac profile due to the relative lack of anticholinergic effects. Publications about cardiac toxicities of trazodone are scant. A 55-year-old woman presented with acute disorder of consciousness secondary to an intentional trazodone overdose.
She was found to have seizure activity without cerebral edema. The initial electrocardiogram was unremarkable, with a normal QTc interval. She eventually developed QTc prolongation that evolved into ventricular tachycardia, and then into a transient right bundle-branch block, left anterior fascicular block, and variable degrees of atrioventricular nodal blocks at 12–24 h after ingestion.
She then developed generalized tonic-clonic seizures, cardiogenic shock, and respiratory arrest. She was intubated and treated with antiepileptics, norepinephrine, and dopamine infusion. QTc interval prolongation gradually resolved and the various forms of heart block did not recur after at 24–36 h.
- She did not require transcutaneous pacing, and was successfully extubated with intact neurological function.
- Fatal arrhythmias can occur in trazodone overdose.
- Close monitoring and supportive care are crucial for patient survival.
- MeSH Keywords: Arrhythmias, Cardiac; Atrioventricular Block; Bundle-Branch Block; Drug Overdose; Long QT Syndrome; Trazodone Depression is a major public health problem and is the leading cause of disability in the United States and worldwide,
Depression has significant potential morbidity and mortality, contributing to suicide, with nearly 800 000 people committing suicide every year, Trazodone is a serotonin antagonist and reuptake inhibitor that is widely used for the treatment of depression, anxiety, and insomnia.
Trazodone was the second most prescribed medication for sleep and the sixth most prescribed psychiatric medication in 2016, Trazodone possesses minimal anticholinergic properties, and thus is generally regarded as having less cardiotoxic potential than other antidepressants. Although trazodone was initially thought to have a safe cardiac profile, there has been increasing concern about its cardiotoxicity, as cardiac arrhythmias in trazodone overdose cases became known,
Here, we report the case of a patient who intentionally overdosed on trazadone who developed QTc prolongation, wide-complex tachycardia, and variable heart blocks arrhythmias as a result of trazodone cardiotoxicity. The patient was a 55-year-old woman with no known chronic illness who was brought in by ambulance for altered mentation.
She was last seen conversing normally on the day before hospital admission. At about midnight, the patient reportedly told her son that she had ingested a large amount of trazodone, apparently in an attempt to commit suicide. The exact dosage was unknown, but she said she took all that remained of a bottle of trazodone (50 milligrams, 90 tablets when full).
The bottle was not full when she took it and the possible ingested dose could have been 2000–4500 milligrams. According to the son, the patient was initially well but acutely decompensated, with what he described as staggering movement, loss of balance, and complete unresponsiveness, with purposeless shaking and twitching.
Paramedics were called, and upon arrival the patient was found minimally responsive and notably hypertensive and tachycardic. No seizures were observed and she was brought to the Emergency Department of our center. She arrived approximately 3–4 h after ingestion, and her initial vitals were: blood pressure 228/120 mmHg, heart rate beats 105 per minute, axillary temperature 37.1°C, respiratory rate 14 breaths per minute, and oxygen saturation 95% on room air.
On examination, she had spontaneous eye opening but was without any response to verbal stimuli. Nonspecific eye twitching was noted and she did not blink to threat. She grimaced to painful stimuli but did not localize pain. There was rigidity in the proximal muscle groups but flaccidity in the distal muscle groups.
- Periods of purposeful-seeming movements, grabbing at the blanket and attempting to cover herself were noted.
- Gag and cough reflexes were intact, without any concern for airway compromise at that time.
- A computed tomography of the brain was negative for acute pathology, ruling out head injury, acute intracranial bleed, or any other space-occupying lesions.
Due to high suspicion of subclinical seizure activity, the patient was loaded with intravenous levetiracetam 1 gram twice daily. There was minimal improvement after administration of the antiepileptics. She was given intravenous hydralazine 10 mg twice to reduce the systolic blood pressure to below 180 mmHg.
- Her status did not change noticeably for the next few hours, as she remained nonverbal, with occasionally purposeful-appearing movements punctuated by minimal responsiveness and staring into space.
- Initial electrocardiogram showed sinus rhythm, U waves, QTc interval of 390 ms, without evidence of heart block ().
Initial laboratory results were significant for hypokalemia, with potassium of 2.7, which was treated with slow intravenous infusion of potassium chloride; however, her serum magnesium and phosphorous levels were normal. Serum alcohol level, salicylate, and acetaminophen levels were undetectable and a urine toxicology screen was also negative.
- There was little neurological improvement on reassessment the following morning.
- Approximately 12 h after ingestion, a significant widening of the QTc interval was observed on telemetry.
- A repeat electrocardiogram showed the QTc interval increased to 519 ms and P pulmonale ().
- A repeated electrolyte panel showed a potassium level of 3.4, for which further intravenous potassium chloride therapy was given.
At about 15 h after ingestion, telemetry showed abrupt onset of a wide-complex tachycardia at a rate of 126 per min (). The patient was found unresponsive by the registered nurse, but still with a thready pulse and without any spontaneous breathing, triggering code blue activation.
The patient was emergently intubated, after which she developed generalized tonic-clonic seizure which was quickly terminated with intravenous pushes of lorazepam. The patient became hypotensive and the rhythm switched to sinus bradycardia at a rate of 40 beats per min, with right bundle-branch block and left anterior fascicular block ().
She also developed first-degree heart block, Wenckebach phenomenon, wandering pacemaker, and a junctional rhythm (–). She was given intravenous pushes of atropine and epinephrine. Chest compression was not started because her pulse was palpable throughout the course.
She was also not cardioverted since the wide-complex tachycardia episode was brief and the rhythm transitioned to brady-arrhythmia. With a provisional diagnosis of cardiogenic shock in the setting of bradycardia and heart blocks, intravenous infusion of norepinephrine and then dopamine were started. She was also loaded with intravenous phenytoin and transferred to the Intensive Care Unit (ICU).
Junctional rhythm with occasional P wave. The right bundle-branch block and the left anterior fascicular block quickly resolved after a few hours (). The norepinephrine and dopamine infusion were eventually titrated off within 12 h after the event. Creatinine kinase levels were elevated, peaking at 5590, with a CKMB index of 0.4.
- Troponin levels were elevated, peaking at 4, which was interpreted as a type II myocardial infarct in the setting of arrhythmia with cardiogenic shock secondary to substance overdose.
- Transthoracic echocardiogram was done while she was intubated, and her left ventricular ejection fraction was 65–70%, without any wall-motion abnormalities.
No further ischemic work-up was warranted at this time. The patient was eventually extubated on the next day. The ICU course was pertinent for aspiration pneumonia in the right lower lobe, which likely happened during her seizures. Her mental status eventually improved and she was responding appropriately to questions over the next few days.
She became hypertensive afterwards, with her systolic blood pressure hovering around 150, but she refused treatment. She confirmed not taking any additional medications in this suicide attempt and did not know the exact number of trazadone pills she took. She was subsequently transferred to an inpatient psychiatric facility to continue treatment of her major depression with suicide attempt.
Trazodone was developed in Italy in 1966. The U.S. Food and Drug Administration (FDA) approved its use for major depression treatment in 1981, Trazodone is both a selective serotonin reuptake inhibitor (SSRI) and a 5HT2 receptor antagonist, and the net result of this action on serotonergic transmission and its role in the antidepressant effect of trazodone is unknown,
- QT prolongation was described in several case reports of trazodone overdose,
- Atrioventricular nodal blockage was also described previously,
- The cellular mechanisms of trazodone cardiotoxicity were explained in a study in which trazodone dose-dependently decreased the maximum upstroke velocity (Vmax), inhibited all of the major ion channels, (IKr, IKs, INa, and ICa), and prolonged the action potential (AP) duration, triggering ventricular arrhythmias in human-induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs),
Trazodone has also been implicated in Torsades de pointes in patients with deliberate trazodone overdose, Our patient presented with wide-complex tachycardia, transient right bundle-branch block, left anterior fascicular block, and variable degrees of atrioventricular nodal block, which eventually resolved.
- The rhythm was not consistent with Torsades in our case, and our patient did not require pacer placement for her bradyarrhythmia.
- In our patient, hypotension was likely due to cardiogenic shock in the setting of severe arrhythmia burden, and vasopressors were eventually titrated off as her rhythm improved.
It is also noted that severe hypotension can persist without significant arrhythmias and might need intensive care admission and pressor administration, Serotonin syndrome was reported in trazodone overdose with concomitant intake of other serotonergic agents,
- Serotonin syndrome is classically described as hyperthermia, tachycardia, hypertension, altered mental status, agitation, diaphoresis, tremor, myoclonus, and hyperreflexia.
- Our patient confirmed that she did not take any drugs other than trazadone in her suicide attempt She did not exhibit agitation, tremor, or myoclonus, and there was also no hyperthermia on presentation until she developed aspiration pneumonia and became febrile.
She was only briefly hypotensive during her arrhythmias due to the cardiogenic shock and she did have elevated blood pressure afterwards, which could have been pre-existing prior to drug overdose. Nevertheless, we could not rule out the likelihood of serotonergic activity from acute trazodone overdose, which could possibly explain the development of seizures,
There have been case reports of trazodone overdose in which patients developed hyponatremia because of a syndrome of inappropriate antidiuretic hormone secretion, seizure, and cerebral edema, Our patient’s sodium level had been normal throughout, and repeated CT head scans were negative for cerebral edema.
As stated above, her seizures could have been due to serotonin syndrome, but also possibly could have resulted from acute cerebral ischemic insult from the cardiogenic shock caused by trazodone cardiotoxicity. In our case, there was evidence of an empty bottle of trazodone, and the patient also said she took the medication, which confirmed the diagnosis.
- The serum trazodone level could not be determined, which is a limitation of this case report.
- Trazodone overdose can induce life-threatening electrophysiological abnormalities of the heart, even in those without previous cardiac comorbidity.
- There is no antidote for trazodone overdose, and supportive care is the mainstay of therapy.
It is important to closely monitor for rhythm disturbances and manage these accordingly. Department and Institution where work was done Department of Internal Medicine, St. Mary Medical Center (Dignity Health), Long Beach, CA, U.S.A. Conflict of interest None.1.
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Is trazodone a strong sleeping pill?
Trazodone: What Is It? – Trazodone is not a medication that is primarily designed to produce sleep (a sedative or hypnotic medication). Trazodone was developed as an antidepressant medication. It has an entirely different mechanism of action than Ambien.
Trazodone works by increasing the availability of the neurotransmitter serotonin in the CNS. It is categorized as a serotonin antagonist reuptake inhibitor (SARI), meaning that it primarily blocks the ability of neurons to reabsorb serotonin once it has been released into the central nervous system. This leaves serotonin available in the central nervous system for longer periods of time and theoretically addresses issues with depression.
Because of the chemical composition of trazodone, it has been found to have mild sedating effects, and it is less effective than other antidepressants for the treatment of depression. Therefore, trazodone has found greater utility as a sleep aid than it has as an antidepressant medication.