Trazodone: English spelling of Trazodon

Trazodone is the English spelling of the antidepressant called Trazodon in Germany. Pharmacologically and chemically, it is the same substance. In international medical literature, in English language package inserts, and on some imported preparations, the form Trazodone is found; in German-speaking regions, the spelling Trazodon is standard. This page serves as a note and reference to the detailed active ingredient page for Trazodon.

Trazodone belongs to the group of serotonergic antagonists and reuptake inhibitors (SARI). In Germany it is approved for the treatment of depressive disorders with or without accompanying anxiety disorder and is used off-label at low doses for sleep disorders due to its sedating effect. Known brand names are Trittico and Thombran. A detailed overview of mechanism of action, indications, dosage, side effects, and drug interactions can be found on the Trazodon main page.

Mechanism of Action

Trazodone acts multimodally. At low doses it primarily blocks 5 HT2A receptors, alpha 1 adrenergic receptors, and histamine H1 receptors, which explains the pronounced sedating effect. At higher doses, inhibition of the serotonin reuptake transporter (SERT) is added, which mediates the actual antidepressant effect.

This dose-dependent effect results in the clinical application: low doses act primarily as a sleep aid, higher doses starting at 150 mg per day as an antidepressant. The exact mechanisms and their clinical significance are described in more detail on the Trazodon active ingredient page.

Indications

• Depressive episodes with or without accompanying anxiety disorder, especially with concurrent sleep disorder
• Sleep disturbances in depression, at low doses, often as an add-on to an SSRI or SNRI
• Off-label for chronic sleep disorders, particularly in patients at risk for benzodiazepine dependence
• Off-label for sleep disorders in elderly patients, cautiously dosed due to orthostatic hypotension
• Adjunctive for irritability, aggression, or sleep problems in dementia, individual assessment

A complete overview of indications can be found on the Trazodon main page.

Dosage and Administration

For depression: Start with 50 to 100 mg at night, gradually increase to 150 to 300 mg per day.

For sleep disorders (off-label): 25 to 100 mg approximately 30 to 60 minutes before bedtime.

Administration: Ideally with or shortly after a meal, as nausea and dizziness are reduced this way. Extended-release tablets must not be crushed.

Renal insufficiency: No dose adjustment required as a rule. Hepatic insufficiency: With impaired function, cautious dose adjustment.

Detailed dosing recommendations by indication, age, and comorbidity are available on the Trazodon main page.

Side Effects

Very common: Tiredness, drowsiness the next day, dizziness, dry mouth, headache.

Common: Orthostatic hypotension, drowsiness, nausea, constipation, blurred vision.

Rare but relevant: Priapism (painful erection lasting longer than 4 hours), a urological emergency. Patients must be explicitly informed about this at the start of therapy.

Suicidality: During the first few weeks of any antidepressant therapy, the risk of suicide may be temporarily increased in younger adults. Close medical monitoring is part of safe treatment.

The complete overview of side effects can be found on the Trazodon main page.

Drug Interactions

• CYP3A4 inhibitors (Erythromycin, Clarithromycin, Ketoconazole, Itraconazole, Ritonavir, Grapefruit juice): increased Trazodone levels.
• CYP3A4 inducers (Carbamazepine, Phenytoin, Rifampicin, St. John's Wort): reduced levels.
• SSRIs, SNRIs, MAO inhibitors, tricyclics, triptans, Tramadol, Linezolid, Methylene blue: Increased risk of serotonin syndrome.
• Antihypertensives: Additive hypotensive effect.
• QT-prolonging agents: Cumulative risk for torsades de pointes.
• Alcohol, benzodiazepines, Z-drugs, first-generation antihistamines: Enhanced central depressant effects.

Special Precautions

Spelling: Trazodone with an e at the end is the English form; Trazodon without e is used in German-language sources. Both refer to the same substance. For prescriptions and pharmacy inquiries, the spelling customary in the country should be used.

Pregnancy: Data limited. If absolutely necessary, benefit-risk assessment. Breastfeeding: Transfer into breast milk in small amounts, individual decision.

Children and adolescents: No approval. Use only in specialized centers and individual exceptions.

Cardiac disease: ECG before starting therapy in patients with risk factors such as bradycardia, electrolyte disturbances, structural heart disease, history of syncope, or family history of QT prolongation.

Discontinuation: Do not stop Trazodone abruptly; taper over at least two weeks to avoid withdrawal phenomena such as sleep disturbances, irritability, dizziness, or flu-like symptoms.

Driving ability: Often impaired during the initial dosing phase and the next day.

Priapism: Every patient should be informed about the possibility of a painful erection lasting longer than 4 hours. If this occurs, seek immediate urological emergency care.

You may also be interested in

• Trazodon, the pharmacological base text for the substance
• Agomelatin, melatonergic antidepressant with good sleep profile
• Paroxetine, SSRI for depression and anxiety disorder
• Zolpidem, Z-drug for short-term sleep-onset insomnia
• Tryptophan, amino acid to support sleep

Frequently Asked Questions

Sources

• Gelbe Liste, Trazodon active ingredient profile
• BfArM, Federal Institute for Drugs and Medical Devices
• AWMF, S3 Guideline Unipolar Depression
• EMA, European Medicines Agency