Trazodone drug interactions

Trazodone has relatively few drug interactions. Medications that induce or inhibit first-pass metabolism may affect trazodone s plasma concentration. Even though trazodone is commonly used for SSRI-induced insomnia, it may be counter productive. Compounds such as... 

SSRIs DULOXETINE, ST JOHN S WORT, SSRIs, TCAs, TRAZODONE T risk of serotonin syndrome >- For signs and symptoms of serotonin toxicity, see Clinical Features of Some Adverse Drug Interactions, Serotonin toxicity and serotonin syndrome Additive effect. In addition, TCAs inhibit CYP2D6-mediated metabolism of SSRIs Caution with co-administration with TCAs or trazodone. Specialist advice should be sought and alternatives considered. Avoid co-administration of two SSRIs, and SSRIs with duloxetine or St John s wort... 

The possibility of drug-drug interactions with trazodone and other substrates, inducers, and/or inhibitors of CYP3A4 exists (75). 

The manufacturers of trazodone say that in vitro drug metabolism studies suggest that there is a potential for drug interactions when trazodone is given with a potent CYP3A4 inhibitor such as nefazodone. There may be substantial increases in trazodone levels, with the potential for adverse effects, and a lower dose oftrazodone should be considered. The UK manufacturer suggests avoidance of the combination where possible. ... 

Major drug interactions trazodone interacts with MAOIs with the risk of serotonin syndrome. When switching between trazodone and an MAOI, a 2-week no-trazodone no-MAOI gap is necessary to safely stop and start treatment Trazodone should not be stopped abruptly. Trazodone interacts with alcohol with worsening sedation. Tegretol decreases blood levels while Nizoral and Norvir increase blood levels of trazodone. Co-administration of trazodone can increase blood concentrations of digoxin and phenytoin. Trazodone may also pass into breast milk and affect a nursing baby. 

Trazodone Hydrochloride Trazodone overdose causes severe toxic effects. These effects are severe if taken along with benzodiazepines or alcohol. Trazodone interacts with MAOIs, cardiovascular drugs, CNS depressants, and antiepileptics. 

Propotnik M, Waschgler R, Konig P, Moll W, Conca A. Therapeutic drug monitoring of trazodone are there pharmacokinetic interactions involving citalopram and fluoxetine Int J Clin Pharmacol Ther 2004 42 120-4. 

The MAO inhibitor tranylcypromine is amphetamine-like in structure but interacts only weakly at DA transporters. The phenylpiperazine nefazodone, and to a lesser extent, the structurally related trazodone have weak inhibitory actions on 5-HT transport nefazodone also may have a minor effect on NE transport. This agent also has a prominent direct antagonistic effect at S-HT receptors that may contribute to antidepressant and anxiolytic activity. Both drugs also may inhibit presynaptic 5-HTj subtype autoreceptors to enhance neuronal release of 5-HT, though they probably also exert at least partial-agonist effects on postsynaptic 5-HTj receptors. Trazodone also blocks cerebral and Hj receptors, possibly contributing to its tendency to induce priapism and sedation, respectively. 

Cozzolino G, Pazzaglia I, De Gaetano V, Macri M. Clinical investigation on the possible interaction between anti-coagulants and a new psychotropic drug (Trazodone). Clin Eur (1972) 11, 593-607,... 

Also note that the development of the serotonin syndrome has been attributed to the sequential use of an SSRI (fluoxetine, paroxetine, or sertraline) and venlafaxine. It has also occurred with concurrent use of venlafaxine and mirtazapine or trazodone. The manufacturers of venlafaxine caution its use with other drugs that affect serotonergic transmission, such as the SSRIs because of the potential risks of the serotonin syndrome. For more about the serotonin syndrome see Additive or synergistic interactions , (p.9). 

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