Trazodone

Medically Reviewed by Dr. Harshi Dhingra, M.D.

Last Reviewed: Jul 25, 2022

Warnings

Trazodone Risks, Warnings, and Complications

Trazodone tablets can cause serious health problems, especially in certain high-risk patients. Some of the risks of trazodone therapy include:

SUICIDAL THINKING: Trazodone can increase the risk of suicidal ideation, especially in people aged 24 years or younger. The risk is greater when trazodone is first started or the dose is changed. You should watch out for worsening depression or any unusual changes in behavior or mood and report immediately to your healthcare provider.
RISK OF SEROTONIN SYNDROME: Rarely, taking trazodone can lead to serotonin syndrome, which is a rare but serious condition in which there is an excessive amount of serotonin in the central nervous system. The risk of serotonin syndrome is higher if there is concomitant administration of other CNS drugs that affect serotonin levels, such as other antidepressants, triptans for migraine headaches, lithium, or St. John's Wort. Give your doctor and pharmacist a complete list of medications, including prescription and over-the-counter medicines, herbal products, and supplements before initiating treatment with trazodone so that they can check for any possible drug interactions. Symptoms of serotonin syndrome may include sweating, fast heart rate, muscle spasms, fever, and confusion. Contact your doctor or get immediate medical help if you experience these symptoms.
LOW BLOOD PRESSURE: Trazodone can cause orthostatic hypotension (dizziness and a sudden fall in blood pressure when going from a sitting or lying position to standing). The risk is higher in older adults (age 65 and above). Change positions slowly to avoid these symptoms. If the symptoms persist, talk to your doctor about other drugs to treat your depression.
ABNORMAL HEART RHYTHM: In some depressed patients, trazodone can cause the heart to beat abnormally. The risk is higher in people who have pre-existing heart rhythm problems or a recent heart attack, a family history of heart problems, low potassium or magnesium levels, those who are taking certain drugs that affect heart rhythm, those on high doses of trazodone, and those with liver problems. Contact your doctor or seek emergency medical help if you experience symptoms such as dizziness, chest pain, or difficulty breathing.
IMPAIRED FOCUS AND CONCENTRATION: Trazodone may cause dizziness and drowsiness and impair your ability to concentrate. Avoid driving a motor vehicle or operating machinery until you know how this medicine affects you. The risk is higher if you consume alcohol or take other medicines that can make you less alert.
INCREASED RISK OF BLEEDING: Trazodone can increase the risk of bruising or bleeding, especially if you're also on other blood thinning medications such as warfarin (Coumadin), aspirin, and NSAIDs (ibuprofen, naproxen). Contact your doctor without delay if you notice any unusual bruising or bleeding, pink or red urine, black-colored stools, nosebleeds, or bleeding gums.
LOW SODIUM: In a small number of people, trazodone can lead to low sodium levels in the blood. This can cause heart problems, including a heart attack. The risk is greater in older adults and people taking diuretics (water pills). Your doctor may ask you to have regular blood tests while on trazodone to check blood sodium levels. Call your doctor right away if you experience symptoms such as weakness, confusion, headache, problems concentrating, or memory problems.
PRIAPISM: Very rarely, trazodone can cause priapism, which is a prolonged, painful erection lasting 6 hours or more. This is a medical emergency and can lead to irreversible damage if untreated. If you have an erection lasting 4 hours or more, with or without pain, stop trazodone and seek immediate medical help.
MANIA: Depression is sometimes the presenting symptom of a mental illness like bipolar disorder. If someone with bipolar is given an antidepressant like trazodone, it can bring on a manic episode with symptoms like euphoria, overactivity, and delusions. Give your doctor a complete medical history before starting trazodone.

Your doctor or pharmacist can prescribe other medications to treat your depression and decrease anxiety if you are at high risk of complications from trazodone use.

Precautions Before Starting Trazodone

Tell your doctor if you have previously had allergic reactions to trazodone, any active or inactive ingredient in trazodone tablets, or any other medications. Your pharmacy can provide you with a list of ingredients.

Tell your doctor about all your health conditions. Trazodone may not be not right for people with certain health conditions. Tell your doctor if you or someone in your family has a history of QT prolongation, or if you have had a heart attack, heart disease, high blood pressure, low sodium, bleeding problems, excessive alcohol use, multiple myeloma, leukemia, sickle cell anemia, Peyronie’s disease, liver disease, or kidney disease.

Give your doctor a complete list of your medications, including prescription drugs, over-the-counter medicines, vitamins, dietary supplements, and herbal products. This can help avoid serious interactions and adverse effects.

Tell your doctor if you are taking monoamine oxidase inhibitors (MAO inhibitors), such as linezolid, isocarboxazid (Marplan), methylene blue, selegiline (Eldepryl, Zelapar, Emsam), phenelzine (Nardil), or tranylcypromine (Parnate), or if you took these medications within the past 14 days. Your doctor will likely tell you not to take trazodone or wait 14 days after your last dose of MAO inhibitors.

Tell your doctor if you are pregnant, could be pregnant, planning to get pregnant, or breast feeding.

Precautions During Use of Trazodone

Keep all your doctors’ appointments while on trazodone. Your doctor may need to adjust your trazodone dose and/or order laboratory tests to keep an eye on certain parameters like blood sodium levels.

People under the age of 24 years can experience unexpected mental health changes and suicidality on trazodone. Call your doctor if you notice any unusual changes in mood or behavior in yourself or a family member who is on trazodone.

Trazodone can make you dizzy and drowsy. Do not drive a motor vehicle, operate machinery, or do anything that requires focus until you know how this medicine affects you. Remember that alcohol can make the drowsiness caused by trazodone worse.

Call your doctor if you become pregnant while on trazodone.

Trazodone can cause a condition called closed-angle glaucoma. Get immediate medical help if you experience symptoms such as nausea, eye pain, vision changes, or swelling around the eyes.

Tell your healthcare providers you are on trazodone before any surgery, including dental procedures.

Trazodone Drug Interactions

Taking trazodone with certain other medicines can affect how it works. Interactions can also increase the risk of serious adverse effects. Your physician may choose a different antidepressant for you, change the dose or frequency of one or both medicines, or monitor you carefully for side effects if there are known interactions between trazodone and any of your other medicines.

Trazodone can have interactions with the following medications:

Monoamine oxidase inhibitors (MAOIs) taken within the last 14 days.
Antiarrhythmics such as amiodarone (Nexterone, Pacerone), sotalol (Betapace, Sorine, Sotylize), disopyramide (Norpace), procainamide, and quinidine (in Nuedexta)
Anticoagulants like warfarin (Coumadin, Jantoven), dabigatran (Pradaxa), and rivaroxaban (Xarelto)
Antiplatelet medications like clopidogrel (Plavix)
NSAIDs such as aspirin, ibuprofen (Motrin, Advil), and naproxen (Naprosyn, Aleve)
Anti-anxiety drugs like buspirone
Antidepressants selective serotonin reuptake inhibitors (SSRIs) such as escitalopram (Lexapro), citalopram (Celexa), fluoxetine (Prozac), paroxetine (Paxil), fluvoxamine (Luvox), and sertraline (Zoloft)
Tricyclic antidepressants like amitriptyline, clomipramine (Anafranil), amoxapine (Asendin), desipramine (Norpramin), imipramine (Tofranil), doxepin (Sinequan), nortriptyline (Pamelor), trimipramine, and protriptyline
Sedatives and tranquilizers
Anticonvulsants like carbamazepine (Carbatrol, Tegretol), phenobarbital, and phenytoin (Phenytek, Dilantin)
Antipsychotics like chlorpromazine, thioridazine, and ziprasidone (Geodon)
Antimanic drugs like lithium (Lithobid)
Antifungal medications like ketoconazole, itraconazole (Sporanox, Tolsura), and voriconazole (Vfend)
Antibiotics like clarithromycin (Biaxin) and rifampin (Rifadin, Rimactane)
HIV medications like indinavir (Crixivan)
Heart medications like digoxin (Lanoxin)
Diuretics (water pills)
Pain medications like fentanyl (Duragesic, Actiq, Subsys, Fentora) and tramadol (Ultram, in Ultracet, Conzip, Qdola)
Migraine medications like eletriptan (Relpax), almotriptan, frovatriptan (Frova), rizatriptan (Maxalt), naratriptan, and sumatriptan (Imitrex)

This list does not describe all possible interactions between trazodone and other drugs. Give your doctor a complete list of your medications, including prescription and non-prescription drugs, vitamins and dietary supplements, and herbal remedies. Also tell your doctor if you smoke, drink alcohol, or use recreational drugs because some of these substances can cause serious health complications when used with prescription drugs.

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