Trazodone withdrawal (A complete guide)

In this blog, we will discuss Trazodone withdrawal, most common uses, side effects, precautions, potential interactions with other drugs and substances

If you suddenly stop taking trazodone, you may experience withdrawal symptoms such as anxiety, agitation, or difficulty falling asleep or staying asleep. Your doctor will probably decrease your dose gradually.

What is Trazodone?

Trazodone is considered an antidepressant drug that belongs to the group of Serotonin Reuptake Inhibitors or SSRIs. It is used frequently for treating people with depression. 

This drug was developed in Italy in the 1960s as antidepressant medication.

Initially, due to the side effects, this antidepressant wasn’t widely accepted in the medical community, however, it became recognized by many internists and clinicians because of the potential benefits of the drug, especially when administered at low doses.

Under the name trazodone (generic) in 1981, it was approved by the U.S Food and Drug Administration (FDA) under the brand name Desyrel.

Today, it is prescribed under the brand name Olepro to treat sleep disorders such as insomnia as well as anxiety disorder and unibipolar depression.

Does trazodone cause sleepiness?

For many people, this drug has a sedative effect that causes a relaxing effect and feeling sleepy.

In prescribing the drug for sleep disorders, physicians typically recommend taking a low dose at bedtime in order to limit the effects of drowsiness.

Still, some people report lingering effects, including sluggishness and feeling drained or low energy, particularly upon waking.

How does Trazodone work?

Trazodone is meant to restore the depleted chemical chemicals in the brain (neurotransmitters).

One of the most important neurotransmitters is serotonin which subsequently helps to improve your mood, appetite, memory, sexual function and desire, energy levels, decrease anxiety and insomnia related to depression.

Researches have found that depression involves an imbalance among the neurotransmitters acetylcholine, norepinephrine, dopamine, and serotonin.

It is believed that trazodone affects the brain’s neurotransmitters by inhibiting the uptake of serotonin by nerves and stimulating other nerves.

How quickly does it work?

Some patients who take the drug for a sleep disorder have indicated that they can experience the sedative effect within 30 mins after the intake.

People who take it as an antidepressant may start noticing benefits after 1 or 2 weeks of consistently taking the medicine and it may take up to 4 weeks to experience the full benefits and desired results. 

How should I take it?

The initial dose is usually reported as 150 mg orally per day in divided doses.

This may be increased by 50 mg orally per day every 3 – 4 days.

The maximum dose reported for inpatients is 600 mg a day and for outpatients is 400 mg a day.

Administration

Applies to the following strengths administered to adults:

– 50 mg

– 100 mg

– 150 mg

– 300 mg

The tablets can be swallowed whole or taking it as a half tablet by breaking it along the scoreline.

Additionally, the tablets should not be chewed or crushed. 

When will I see results?

It can take up to 2 weeks before you start seeing improvement.

If your symptoms are not improving, do not stop the medication and talk to your doctor about it because you could have some unpleasant withdrawal symptoms. 

What happens if I miss a dose?

If you miss a dose, take the missing dose as soon as you remember.

If it is almost time to take the next scheduled dose, discard the missing dose and keep taking it as usual.

Do not take an extra or doubled dose to compensate. 

What happens if I overdose?

If you overdose with Trazodone, seek immediate medical attention.

An overdose can be fatar if it is combined with alcohol, barbiturates such as pehnobarbital, or sedatives such as diazepam.

Overdose symptoms may include:

• Extreme drowsiness
• Vomiting
• Prolonged and painful erection
• Faster heartbeats
• Seizures 
• Breathing that is slow or stops

Symptoms of an allergic reaction

Trazodone allergic reactions need medical assistance.

If you are experiencing the following symptoms while taking Trazodone, it is very likely that you are allergic to it:

• Hives
• Difficulty breathing
• Swelling of your face, lips, tongue or throat

Side effects

Report to your doctor any sudden changes related to your mood or behavior, as being impulsive, aggressive, restless, feeling irritable, increased anxiety, panic attacks, trouble sleeping or if you are feeling agitated, hyperactive, even more depressed than before or if you are having suicidal thoughts or wanting to hurt yourself. 

Moreover, if you have shortness of breath, faster or slower heartbeats, sudden dizziness, easy bruising or unusual bleeding; low levels of sodium in your body that will manifest in headaches, confusion, slurred speech, feeling fatigued, vomiting, loss of coordination or feeling unsteady. 

Serotonin syndrome

Trazodone can cause serotonin syndrome and symptoms include:

• Hallucinations
• Fever
• Sweating
• Overactive reflexes
• Fainting
• Shivering
• Faster heart rate
• Muscle stiffness
• Twitching
• Loss of coordination
• Nausea
• Vomiting
• Diarrhea

Common side effects

The common side effects of Trazodone intake may include:

• Drowsiness
• Dizziness
• Tiredness
• Swelling
• Weight loss
• Blurred Vision
• Diarrhea
• Constipation
• Stuffy nose
• Headaches
• Nausea
• Vomiting
• Xerostomia

Other side effects

• Syncope
• Edema
• Ataxia
• Confusion
• Diarrhea
• Hypotension
• Insomnia
• Sedated state
• Tachycardia

Less common side effects 

• Burning, crawling, itching, numbness, prickling, “pins and needles”, or tingling feelings
• Confusion about identity, place, and time
• Decreased concentration
• Fainting
• A general feeling of discomfort or illness
• Headache
• Lack of coordination
• Muscle tremors
• Nervousness
• Pounding in the ears
• Shortness of breath
• Slow or fast heartbeat
• Swelling

Trazodone Drug interaction

There are many drugs that can interact with Trazodone, especially:

• Any other antidepressant
• Anagrelide
• Droperidol
• Methadone
• Ondansetron
• Antibiotics such as azithromycin, clarithromycin, erythromycin, levofloxacin, moxifloxacin, pentamidine
• Cancer medicine such as arsenic trioxide, vandetanib
• Anti-malaria medication such as chloroquine, halofantrine
• Heart rhythm medicine such as amiodarone, disopyramide, dofetilide, dronedarone, flecainide,  ibutilide, quinidine, sotalol
• Medicine to treat a psychiatric disorder such as chlorpromazine, haloperidol, pimozide, thioridazine.
• Phenytoin
• St johns wort
• Tramadol
• Diuretic or “water pill”
• Anti-anxiety medication
• Other drugs to treat mood disorders or other mental illnesses such as schizophrenia
• Blood thinners such as warfarin, coumadin, and jantoven
• Migraine headache medicine such as sumatriptan, imitrex, maxalt, treximet, among others

This is not a complete list of the drugs that can interact with Trazodone for more information about additional drugs that may interact ask your doctor. 

Trazodone and alcohol interaction

It is advised to avoid or limit alcohol consumption while being treated with Trazodone.

Alcohol intake while using Trazodone can increase the side effects and in addition, some people may also experience impairment in thinking and judgment. 

Is it safe to take trazodone for insomnia?

Trazodone is widely prescribed as a nighttime sleep aid for people with acute insomnia, even though it was originally designed to treat depression and anxiety disorders. 

Is trazodone different from other “sleeping pill” drugs?

The most commonly prescribed drugs as sleeping aid are Ambien, Sonata, Lunesta , but Trazodone differs from them in a few ways such as:

• Ambien and Lunesta are classified as controlled substances because they have the potential for misuse and abuse, including dependence or addiction
• Trazodone is not a controlled substance, physicians aren’t limited in how many pills they can prescribe
• It’s an inexpensive generic drug covered by most insurance companies
• It’s not considered to be an addictive substance when used as prescribed
• Trazodone should not be taken by pregnant women or women who are breastfeeding. 

Are there risks with taking trazodone as an antidepressant?

For someone under the age of 24, there are heightened risks in regards to mental health.

According to Medline Plus, the following side effects and symptoms can occur among patients under age 24: “new or worsening depression; thinking about harming or killing yourself, or planning or trying to do so; extreme worry; agitation; panic attacks; difficulty falling asleep or staying asleep; aggressive behavior; irritability; acting without thinking; severe restlessness; and frenzied abnormal excitement.” 

It is important to be aware that the manifestations of any of these symptoms or side effects should be discussed with your doctor immediately. 

It’s also imperative that patients know what to avoid while taking SSRIs, SNRIs or other antidepressants.

Whether a person has a cold, is having trouble sleeping or is searching for allergy relief, they should talk to their doctor before self-treating with an over-the-counter medication.

According to Psychiatry Advisor, one patient who was taking melatonin for insomnia while also prescribed an SSRI woke up with a “headache, dizziness and feeling like his face was on fire”—signs of elevated blood pressure that could have been severe had he taken higher doses.

Taking an antidepressant medication in combination with supplements, such as St. John’s wort or aspirin, can increase the likelihood of upper gastrointestinal bleeding.

To avoid adverse drug reactions, experts advise making a list of all medications, supplements and other OTC drugs, and sharing it with your physician prior to taking trazodone.

Is it safe to use trazodone with alcohol or other drugs?

Absolutely not. Since both alcohol and trazodone affect the central nervous system, the consequences of mixing the two can be deadly.

And mixing the medication with drugs of abuse can result in the onset of serotonin syndrome, a potentially lethal adverse drug reaction.

While the potential for trazodone abuse is fairly low, any amount over 600 mg. in 24 hours is an overdose.

What happens if you take too much trazodone? Can it cause serotonin syndrome?

Serotonin syndrome occurs when, according to Mayo Clinic, “high levels of serotonin accumulate in the body.”

This is a drug-to-drug interaction involving the over-stimulation of central and peripheral receptors.

According to the journal U.S. Pharmacist, “Serotonin syndrome (SS) is caused most often when certain antidepressant agents are taken concurrently with other drugs that modulate synaptic serotonin levels. When patients take two or more antidepressants from different pharmacologic classes, drug-drug interactions may occur; these interactions may lead to potentially severe serotonin toxicity, or serotonin syndrome.”

Clinical symptoms of serotonin syndrome can develop within two hours—or up to 24 hours—after taking an increased dose or adding another serotonergic drug.

Can you become addicted to trazodone?

While the drug is considered non-addictive and non-habit-forming, it should only be taken as prescribed and under a physician’s care in order to avoid misuse.

This is especially important for individuals who have a history of substance abuse or other drug addiction.

Warning signs of drug misuse include using the sleep aid/antidepressant without a prescription, using the medication at higher doses than prescribed, or snorting or crushing the tablets to speed up the intended effects.

Frequently Asked Questions (FQAs)

References

Drugs.com

Cigna

Hazelden Betty Ford Foundation