Is Trazodone a good sleep aid


TrazodoneDrug groupsAntidepressantsSARITrazodon is a mood-enhancing and sedating antidepressant that is used for the treatment of depression with or without an anxiety disorder. The effects are attributed, among other things, to the inhibition of the reuptake of serotonin in the presynaptic nerve cells and the antagonism of serotonin receptors. Off-label, trazodone is often used as a sleep aid for insomnia in non-depressed patients. However, this practice is not undisputed. The most common possible adverse effects include drowsiness, dry mouth, and pain. When combined with other serotonergic drugs, there is a risk of serotonin syndrome. Trazodone is a substrate for CYP3A4.

synonymous: trazodonum, trazodoni hydrochloridum, trazodone hydrochloride

Products

Trazodone is available in the form of film-coated tablets and prolonged-release tablets (Trittico®, Trittico® retard, Trittico® Uno). The active ingredient was developed by Angelini in Italy in 1966 and has been approved in Switzerland since 1985. Auto generics and generics are registered. Generics of the 100 mg film-coated tablets were first marketed in Switzerland in 2018.

Structure and properties

Trazodone (C.19H22ClN5O, Mr = 371.9 g / mol) is present in medicinal products as trazodone hydrochloride. It is a triazole pyridine and phenylpiperazine derivative and is structurally different from other antidepressants. Trazodone is a white, crystalline powder that is easily soluble in water.

Effects

Trazodone (ATC N06AX05) has antidepressant, calming and, in low doses, sleep-inducing properties. The effects are attributed, among other things, to the inhibition of the reuptake of serotonin in the presynaptic neuron and to the antagonism at 5-HT2 receptors. Trazodone is one of the SARI den Serotonin Antagonists and Reuptake Inhibitors. The sedative effects come on quickly, the antidepressant effects, however, only after one to three weeks.

According to the literature, trazodone is also an alpha blocker, which explains undesirable effects such as low blood pressure and permanent erections (priapism). In contrast to other antidepressants and neuroleptics, trazodone is neither anticholinergic nor antidopaminergic.

Mechanism of action of the reuptake inhibitors, click to enlarge. Illustration © PharmaWiki

Indications

For the treatment of depression with or without an anxiety disorder.

Off-label use

Because of its sedating-hypnotic properties, off-label trazodone is widely used for the treatment of sleep disorders in non-depressed patients. However, the drug has not yet been approved by the authorities for this application and this practice is not undisputed. A detailed discussion can be found, for example, in Mendelson (2005). In connection with depression, the treatment of sleep disorders is mentioned in the product information.

dosage

According to the specialist information. The dose is set individually and gradually. The medicine can be taken as a single dose in the evening before going to bed. Administration in several doses is also possible, preferably directly after meals. The withdrawal should take place gradually.

Contraindications

The complete precautionary measures can be found in the medicinal product information sheet.

Interactions

Trazodone is a substrate for CYP3A4. Corresponding drug interactions with CYP inhibitors or CYP inducers can occur.

The effects of central depressant drugs and alcohol can be intensified. The consumption of alcohol should be avoided during treatment.

When combined with serotonergic agents and MAO inhibitors, a serotonin syndrome can develop. Other interactions have been described.

unwanted effects

The most common possible adverse effects include drowsiness, dry mouth, and pain in the limbs, back, muscles, and joints.

see below

Antidepressants, sleeping pills, serotonin syndrome

literature
  • Pharmaceutical product information (CH, USA)
  • Fink H.A., MacDonald R., Rutks I.R., Wilt T.J. Trazodone for erectile dysfunction: a systematic review and meta-analysis. BJU Int, 2003, 92 (4), 441-6 Pubmed
  • James S.P., Mendelson W.B. The use of trazodone as a hypnotic: a critical review. J Clin Psychiatry, 2004, 65 (6), 752-5 Pubmed
  • Haria M., Fitton A., McTavish D. Trazodone. A review of its pharmacology, therapeutic use in depression and therapeutic potential in other disorders. Drugs Aging, 1994, 4 (4), 331-55 Pubmed
  • Kaneda Y., Ohmori T., Okabe H. Possible mild serotonin syndrome related to co-prescription of tandospirone and trazodone. Gen Hosp Psychiatry, 2001, 23 (2), 98-101 Pubmed
  • Martinon-Torres G., Fioravanti M., Grimley E.J. Trazodone for agitation in dementia. Cochrane Database Syst Rev, 2004, CD004990 Pubmed
  • Mendelson W.B. A review of the evidence for the efficacy and safety of trazodone in insomnia. J Clin Psychiatry, 2005, 66 (4), 469-76 Pubmed
  • Stahl S.M. Multifunctional drugs: a novel concept for psychopharmacology. CNS Spectr, 2009, 14 (2), 71-3 Pubmed
  • Stahl S.M. Mechanism of action of trazodone: a multifunctional drug. CNS Spectr, 2009, 14 (10), 536-46 Pubmed
author

Conflicts of Interest: None / Independent. The author has no relationship with the manufacturer of the products mentioned and is not involved in sales.

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