TRAZODONE HYDROCHLORIDE

TRAZODONE HYDROCHLORIDE
(tray'zoe-done)
Classifications: psychotherapeutic agent; antidepressant;
Therapeutic: antidepressant
Prototype: Imipramine
Pregnancy Category: C

Availability

50 mg, 100 mg, 150 mg, 300 mg tablets

Action

Centrally acting antidepressant chemically and structurally unrelated to tricyclic, tetracyclic, or other antidepressants. Potentiates serotonin effects by selectively blocking its reuptake at presynaptic membranes in CNS. Produces varying degrees of sedation in normal and mentally depressed patient.

Therapeutic Effect

Increases total sleep time, decreases number and duration of awakenings in depressed patient, and decreases REM sleep. Has antianxiety effect in severely depressed patient.

Uses

Both inpatient and outpatient with major depression with or without prominent anxiety.

Unlabeled Uses

Adjunctive treatment of alcohol dependence, anxiety neuroses, drug-induced dyskinesias, insomnia.

Contraindications

Initial recovery phase of MI; ventricular ectopy; electroshock therapy; suicidal ideation; pregnancy (category C). Safe use in children <6 y is not established.

Cautious Use

Bipolar disorder, older adults; history of suicidal tendencies; cardiac arrhythmias or disease; hepatic disease, renal impairment; lactation.

Route & Dosage

Depression
Adult: PO 150 mg/d in divided doses, may increase by 50 mg/d q3–4d (max: 400–600 mg/d)
Geriatric: PO 25–50 mg h.s., may increase q3–7d to usual range of 75–150 mg/d
Child (6–18 y): PO 1.5–2 mg/kg/d in divided doses, increase q3–4d prn (max: 6 mg/kg/d)

Administration

Oral

Give drug with food; increases amount of absorption by 20% and appears to decrease incidence of dizziness or light-headedness. Maintain the same schedule for food-drug intake throughout treatment period to prevent variations in serum concentration.
Store in tightly closed, light-resistant container at 15°–30° C (59°–86° F).

Adverse Effects (≥1%)

CNS: Drowsiness, light-headedness, tiredness, dizziness, insomnia, headache, agitation, impaired memory and speech, disorientation. CV: Hypotension (including orthostatic hypotension), hypertension, syncope, shortness of breath, chest pain, tachycardia, palpitations, bradycardia, PVCs, ventricular tachycardia (short episodes of 3–4 beats). Special Senses: Nasal and sinus congestion, blurred vision, eye irritation, sweating or clamminess, tinnitus. GI: Dry mouth, anorexia, constipation, abdominal distress, nausea, vomiting, dysgeusia, flatulence, diarrhea. Urogenital: Hematuria, increased frequency, delayed urine flow, early or absent menses, male priapism, ejaculation inhibition. Hematologic: Anemia. Musculoskeletal: Skeletal aches and pains, muscle twitches. Skin: Skin eruptions, rash, pruritus, acne, photosensitivity. Body as a Whole: Weight gain or loss.

Interactions

Drug: antihypertensive agents may potentiate hypotensive effects; alcohol and other cns depressants add to depressant effects; may increase digoxin or phenytoin levels; mao inhibitors may precipitate hypertensive crisis; ketoconazole, indinavir, ritonavir may increase levels and toxicity. Herbal: Ginkgo may increase sedation.

Pharmacokinetics

Absorption: Readily from GI tract. Onset: 1–2 wk. Peak: 1–2 h. Distribution: Distributed into breast milk. Metabolism: In liver. Elimination: 75% in urine, 25% in feces. Half-Life: 5–9 h.

Nursing Implications

Assessment & Drug Effects

Monitor pulse rate and regularity before administration if patient has preexisting cardiac disease.
Note: Adverse effects generally are mild and tend to decrease and disappear after the first few weeks of treatment.
Monitor children and adolescents for changes in behavior that indicate increased suicidality.
Observe patient's level of activity. If it appears to be increasing toward sleeplessness and agitation with changes in reality orientation, report to physician. Manic episodes have been reported.
Check patient for symptoms of hypotension. If orthostatic hypotension is troublesome, suggest measures to reduce danger of falling and help patient to tolerate the effects. Discuss with physician; reduction of dose or discontinuation of the drug may be prescribed.
Male patient should report inappropriate or prolonged penile erections. The drug may be discontinued.
Be aware that overdose is characterized by an extension of common adverse effects: Vomiting, lethargy, drowsiness, and exaggerated anticholinergic effects. Seizures or arrhythmias are unusual.

Patient & Family Education

Expect therapeutic response to begin in 1 wk; may require 2–4 wk to reach maximum levels. Adhere to regimen.
Do not alter dose or intervals between doses.
Consult physician if drowsiness becomes a distressing adverse effect. Dose regimen may be changed so that largest dose is at bedtime.
Limit or abstain from alcohol use. The depressant effects of CNS depressants and alcohol may be potentiated by this drug.
Do not self-medicate with OTC drugs for colds, allergy, or insomnia treatment without advice of physician. Many of these drugs contain CNS depressants.
Keep follow-up appointments to permit dose adjustment or discontinuation, as indicated.
Alert dentist, surgeon, or emergency personnel that drug is being used. Trazodone is discontinued as long as possible prior to elective surgery.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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