Formulary
Trazodone hydrochloride: Indications, Dosing, Side Effects and Interactions
Trazodone hydrochloride clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 4 min read
Trazodone hydrochloride: Indications, Dosing, Side Effects and Interactions
Trazodone hydrochloride clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Depressive illness (particularly where sedation is required)**
- **Adult** (By Mouth): 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** (By Mouth): 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**
- **Adult** (By Mouth): 75 mg daily, increased if necessary to 300 mg daily.
Cautions
Arrhythmias; cardiovascular disease; chronic constipation; epilepsy; history of bipolar disorder; history of psychosis; hyperthyroidism (risk of arrhythmias); increased intra-ocular pressure; patients with a significant risk of suicide; prostatic hypertrophy; susceptibility to angle-closure glaucoma; urinary retention Cautions, further information Manufacturer advises 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; manufacturer advises low initial doses should be used, with close monitoring, particularly for psychiatric and cardiac side-effects.
Contraindications
During the manic phase of bipolar disorder; immediate recovery period after myocardial infarction
Side effects
Frequency not known 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 (discontinue-potentially fatal); oedema; pain; palpitations; paraesthesia; paralytic ileus; postural hypotension; priapism (discontinue); QT interval prolongation; seizure; serotonin syndrome; SIADH; skin reactions; sleep disorders; suicidal behaviours; 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 .
Interactions
**Severe interactions:**
- Phenothiazines : Severe orthostatic hypotension has been observed in case of concomitant use of phenothiazines, like e.g.
- Serotonin syndrome : Molipaxin/Trazodone should be used cautiously when co-administered with: Buprenorphine/opioids, as the risk of serotonin syndrome, a potentially life-threatening condition, is...
**Other interactions (27):**
- General: The sedative effects of antipsychotics, hypnotics, sedatives, anxiolytics, and antihistaminic drugs may be intensified; dosage reduction is recommended in such instances.
- The metabolism of antidepressants is accelerated due to hepatic effects by oral contraceptives, phenytoin, carbamazepine and barbiturates.
- The metabolism of antidepressants is inhibited by cimetidine and some other antipsychotics.
- In vitro drug metabolism studies suggest that there is a potential for drug interactions when Molipaxin/Trazodone is given with potent CYP3A4 inhibitors such as erythromycin, ketoconazole,...
- Exposure to ritonavir during initiation or resumption of treatment in patients receiving Molipaxin/Trazodone will increase the potential for excessive sedation, cardiovascular, and gastrointestinal...
- It has been confirmed in in-vivo studies in healthy volunteers, that a ritonavir dose of 200 mg BID increased the plasma levels of Molipaxin/Trazodone by greater than two-fold, leading to nausea,...
Pregnancy
Avoid during first trimester-limited information available. Monitor infant for signs of withdrawal if used until delivery.
Breast feeding
The amount secreted into breast milk is too small to be harmful.
Hepatic impairment
Manufacturer advises caution, particularly in severe impairment (increased risk of side-effects).
Renal impairment
Use with caution, particularly in severe impairment. M
Medicinal forms
Solution,Tablet,Capsule,Solution
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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