trazodone hydrochloride

trazodone hydrochloride

(traz' oh done)

Apo-Trazodone (CAN), Desyrel, Desyrel Dividose, Nu-Trazodone (CAN)

Pregnancy Category C

Drug classes

Antidepressant

Therapeutic actions

Mechanism of action unknown; differs from other antidepressants in that it is a triazo compound, not a TCA, an amphetamine-like CNS stimulant, or an MAOI; inhibits the presynaptic reuptake of the neurotransmitter serotonin and potentiates the behavioral effects of the serotonin precursor; the relation of these effects to clinical efficacy is unknown.

Indications

·        Treatment of depression in inpatient and outpatient settings and for depressed patients with and without anxiety

·        Unlabeled uses: Treatment of aggressive behavior, cocaine withdrawal, insomnia, alcoholism, panic disorders, schizophrenic disorders, drug-induced dyskinesias

Contraindications and cautions

·        Contraindicated with hypersensitivity to trazodone, recent MI.

·        Use cautiously with preexisting cardiac disease (arrhythmias, including ventricular tachycardia, may be more likely), lactation, pregnancy.

Available forms

Tablets—50, 100, 150, 300 mg

Dosages

ADULTS

Initially, 150 mg/day PO. May be increased by 50 mg/day every 3–4 days. Maximum dose for outpatients should not exceed 400 mg/day in divided doses. Maximum dose for inpatients or those severely depressed should not exceed 600 mg/day in divided doses. Use lowest effective dosage for maintenance.

PEDIATRIC PATIENTS < 18 YR

Safety and efficacy not established.

GERIATRIC PATIENTS

Initially, 75 mg/day PO in divided doses. Monitor patient closely.

Pharmacokinetics

Route	Onset	Peak
Oral	Varies	1–2 hr

Metabolism: Hepatic; T_1/2: 3–6 hr and then 5–9 hr

Distribution: Crosses placenta; may enter breast milk

Excretion: Feces, urine

Adverse effects

·        CNS: Anger, hostility, agitation, nightmares or vivid dreams, hallucinations, delusions, hypomania, confusion, disorientation, decreased concentration, impaired memory, impaired speech, dizziness, incoordination, drowsiness, fatigue, excitement, insomnia, nervousness, paresthesia, tremors, akathisia, headache, grand mal seizures, tinnitus, blurred vision, red eyes, nasal or sinus congestion, malaise

·        CV: Hypertension, hypotension, shortness of breath, syncope, tachycardia, palpitations, chest pain, MI, ventricular ectopic activity, occasional sinusbradycardia with long-term use

·        GI: Abdominal or gastric disorder, decreased or increased appetite, bad taste in mouth, dry mouth, hypersalivation, nausea, vomiting, diarrhea, flatulence, constipation

·        GU: Decreased libido, impotence, priapism, retrograde ejaculation, early menses, missed periods, hematuria, delayed urine flow, increased urinary frequency

·        Hematologic: Anemia, neutropenia, leukopenia, liver enzyme alterations

·        Hypersensitivity: Allergic skin conditions, edema, rash

·        Musculoskeletal: Musculoskeletal aches and pains, muscle twitches

·        Other: Sweating, clamminess

Interactions

Drug-drug

·        Increased serum levels and toxicity of alcohol, CNS depressants, digoxin, phenytoin

·        Risk of serotonin syndrome if combined with other SSRIs

·        Increased risk of toxicity with phenothiazines

·        Decreased effectiveness with carbamazepine

Drug-alternative therapy

·        Increased risk of severe reaction if combined with St. John's wort therapy

Nursing considerations

Assessment

·        History: Hypersensitivity to trazodone; EST; recent MI, preexisting cardiac disease; pregnancy, lactation

·        Physical: Skin color, lesions; orientation, affect, reflexes, vision and hearing; P, BP, orthostatic BP, perfusion; bowel sounds, normal output, liver evaluation; urine flow, normal output; usual sexual function, frequency of menses; LFTs, urinalysis, CBC, ECG

Interventions

·        WARNING: Ensure that depressed and potentially suicidal patients have access to only limited quantities of drug.

·        Administer shortly after a meal or light snack to enhance absorption.

·        Administer major portion of dose hs if drowsiness occurs.

·        Anticipate symptomatic relief during the first week of therapy with optimal effects within 2 wk (some patients require 2–4 wk to respond).

·        Monitor patient for orthostatic hypotension during therapy.

·        WARNING: Discontinue therapy immediately if priapism occurs.

·        Arrange for CBC if patient develops fever, sore throat, or other signs of infection.

Teaching points

·        Take drug with food or a snack to enhance absorption and decrease likelihood of dizziness.

·        Avoid alcohol, sleep-inducing drugs, and over-the-counter drugs.

·        You may experience these side effects: Ringing in the ears, headache, dizziness, drowsiness, weakness (reversible; safety measures may need to be taken if severe; avoid driving or performing tasks that require alertness); nausea, vomiting, loss of appetite (eat frequent small meals; practice frequent mouth care); dry mouth (suck sugarless candies); changes in sexual function and abilities; nightmares, dreams, confusion, inability to concentrate (may lessen).

·        Report dizziness, light-headedness, faintness, blood in urine, fever, chills, sore throat, rash, prolonged or inappropriate penile erection (discontinue immediately).

Adverse effects in Italic are most common; those in Bold are life-threatening.