Drug reference

Trazodone hydrochloride

BNF 80 (2020–2021)

Source: BNF 80 (2020–2021)
PDF pages: 410, 411

Review source pages for extracted sections and age labels. BNF dose snippets show only their first line.

Overview

Indications And Dose

Depressive illness (particularly where sedation is required) ▶BY MOUTH ▶Adult: Initially 150 mg daily in divided doses, dose to be taken after food, alternatively initially 150 mg once daily, dose to be taken at bedtime, increased if necessary to 300 mg daily; increased if necessary to 600 mg daily in divided doses, higher dose for use in hospital patients only ▶Elderly: Initially 100 mg daily in divided doses, dose to be taken after food, alternatively initially 100 mg once daily, dose to be taken at bedtime, increased if necessary to 300 mg daily; increased if necessary to 600 mg daily in divided doses, higher dose for use in hospital patients only Anxiety ▶BY MOUTH ▶Adult: 75 mg daily, increased if necessary to 300 mg daily

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Contra Indications

During the manic phase of bipolar disorder. immediate recovery period after myocardial infarction

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Cautions

Arrhythmias. cardiovascular disease. chronic constipation. diabetes. epilepsy. history of bipolar disorder. history of psychosis. hyperthyroidism (risk of arrhythmias). increased intra-ocular pressure. patients with a signiﬁcant risk of suicide. phaeochromocytoma (risk of arrhythmias). prostatic hypertrophy. susceptibility to angle-closure glaucoma. urinary retention CAUTIONS, FURTHER INFORMATION Treatment should be stopped if the patient enters a manic phase. Elderly patients are particularly susceptible to many of the side-effects of tricyclic antidepressants; low initial doses should be used, with close monitoring, particularly for psychiatric and cardiac side-effects.

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Prescribing And Dispensing Information

Limited quantities of tricyclic antidepressants should be prescribed at any one time because their cardiovascular and epileptogenic effects are dangerous in overdosage.

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Safety

Interactions

→Appendix 1: trazodone

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Side Effects

Aggression. agranulocytosis. alertness decreased. anaemia. anxiety. aphasia. appetite abnormal . arrhythmias. arthralgia. asthenia. blood disorder. chest pain. confusion. constipation. delirium. delusions. diarrhoea. dizziness. drowsiness. dry mouth. dyspnoea. eosinophilia. fever. gastroenteritis. gastrointestinal discomfort. hallucination. headache. hepatic disorders. hyperhidrosis. hypersalivation. hypertension. hyponatraemia. inﬂuenza like illness. jaundice (discontinue). leucopenia. libido decreased. mania. memory loss. movement disorders. myalgia. nasal congestion. nausea. neuroleptic malignant syndrome. oedema. pain. palpitations. paraesthesia. paralytic ileus. postural hypotension. priapism (discontinue). QT interval prolongation. seizure. serotonin syndrome. SIADH. skin reactions. sleep disorders. suicidal tendencies. syncope. taste altered. thrombocytopenia. tremor. urinary disorder . vertigo. vision blurred. vomiting. weight decreased. withdrawal syndrome SIDE-EFFECTS, FURTHER INFORMATION The risk of side- effects is reduced by titrating slowly to the minimum effective dose (every 2–3 days). Consider using a lower starting dose in elderly patients. Overdose The tricyclic-related antidepressant drugs may be associated with a lower risk of cardiotoxicity in overdosage. Tricyclic and related antidepressants cause dry mouth, coma of varying degree, hypotension, hypothermia, hyperreﬂexia, extensor plantar responses, convulsions, respiratory failure, cardiac conduction defects, and arrhythmias. Dilated pupils and urinary retention also occur. For details on the management of poisoning see Tricyclic and related antidepressants under Emergency treatment of poisoning p. 1430.

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Pregnancy

Avoid during ﬁrst trimester—limited information available. Monitor infant for signs of withdrawal if used until delivery.

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Breast Feeding

The amount secreted into breast milk is too small to be harmful.

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Hepatic Impairment

Manufacturer advises caution, particularly in severe impairment (increased risk of side- effects).

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Renal Impairment

Use with caution in severe impairment.

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Dose and formulations

Medicinal Forms

There can be variation in the licensing of different medicines containing the same drug. Forms available from special-order manufacturers include: oral suspension, oral solution Oral solution CAUTIONARY AND ADVISORY LABELS 2, 21 ▶Trazodone hydrochloride (Non-proprietary) Trazodone hydrochloride 10 mg per 1 ml Trazodone 50mg/5ml oral solution sugar free sugar-free | 120 ml P £180.00 DT = £32.38 Trazodone hydrochloride 20 mg per 1 ml Trazodone 100mg/5ml oral solution sugar free sugar-free | 120 ml P £232.50 DT = £231.31 Tablet CAUTIONARY AND ADVISORY LABELS 2, 21 ▶Trazodone hydrochloride (Non-proprietary) Trazodone hydrochloride 50 mg Trazodone 50mg tablets | 84 tablet P £20.00 Trazodone hydrochloride 100 mg Trazodone 100mg tablets | 56 tablet P £25.00 Trazodone hydrochloride 150 mg Trazodone 150mg tablets | 28 tablet P £34.00 DT = £3.30 ▶Molipaxin (Zentiva) Trazodone hydrochloride 150 mg Molipaxin 150mg tablets | 28 tablet P £16.08 DT = £3.30 Capsule CAUTIONARY AND ADVISORY LABELS 2, 21 ▶Trazodone hydrochloride (Non-proprietary) Trazodone hydrochloride 50 mg Trazodone 50mg capsules | 84 capsule P £35.00 DT = £4.03 Trazodone hydrochloride 100 mg Trazodone 100mg capsules | 56 capsule P £41.00 DT = £4.76 ▶Molipaxin (Zentiva) Trazodone hydrochloride 50 mg Molipaxin 50mg capsules | 84 capsule P £23.92 DT = £4.03 Trazodone hydrochloride 100 mg Molipaxin 100mg capsules | 56 capsule P £28.14 DT = £4.76 ANTIDEPRESSANTS › TETRACYCLIC ANTIDEPRESSANTS

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Clinical care

Treatment Cessation

Withdrawal effects may occur within 5 days of stopping treatment with antidepressant drugs; they are usually mild and self-limiting, but in some cases may be severe. The risk of withdrawal symptoms is increased if the antidepressant is stopped suddenly after regular administration for 8 weeks or more. The dose should preferably be reduced gradually over about 4 weeks, or longer if withdrawal symptoms emerge (6 months in patients who have been on long-term maintenance treatment). If possible tricyclic and related antidepressants should be withdrawn slowly.

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Patient And Carer Advice

Driving and skilled tasks Drowsiness may affect the performance of skilled tasks (e.g. driving). Effects of alcohol enhanced.

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Dose text by age group

Elderly

Initially 100 mg daily in divided doses, dose to

First-line fragment. Read the complete Indications and Dose section above.

PDF page 410

Age labels are extracted for navigation. Check the complete source section and current local guidance before clinical use.

Drug reference

Trazodone hydrochloride

BNF 80 (2020–2021)

Source: BNF 80 (2020–2021)
PDF pages: 410, 411

Review source pages for extracted sections and age labels. BNF dose snippets show only their first line.

Overview

Indications And Dose

PDF page 410

Contra Indications

During the manic phase of bipolar disorder. immediate recovery period after myocardial infarction

PDF page 410

Cautions

PDF page 410

Prescribing And Dispensing Information

Limited quantities of tricyclic antidepressants should be prescribed at any one time because their cardiovascular and epileptogenic effects are dangerous in overdosage.

PDF page 410

Safety

Interactions

→Appendix 1: trazodone

PDF page 410

Side Effects

PDF page 410

Pregnancy

Avoid during ﬁrst trimester—limited information available. Monitor infant for signs of withdrawal if used until delivery.

PDF page 410

Breast Feeding

The amount secreted into breast milk is too small to be harmful.

PDF page 410

Hepatic Impairment

Manufacturer advises caution, particularly in severe impairment (increased risk of side- effects).

PDF page 410

Renal Impairment

Use with caution in severe impairment.

PDF page 410

Dose and formulations

Medicinal Forms

PDF pages 410, 411

Clinical care

Treatment Cessation

PDF page 410

Patient And Carer Advice

Driving and skilled tasks Drowsiness may affect the performance of skilled tasks (e.g. driving). Effects of alcohol enhanced.

PDF page 410

Dose text by age group

Elderly

Initially 100 mg daily in divided doses, dose to

First-line fragment. Read the complete Indications and Dose section above.

PDF page 410

Age labels are extracted for navigation. Check the complete source section and current local guidance before clinical use.