Trazodone indications

MISCELLANEOUS ANTIDEPRESSANTS. An uncommon but potentially serious adverse reaction of trazodone is priapism (a persistent erection of die penis). If not treated within a few hours, priapism can result in impotence The nurse instructs the patient to report any prolonged or inappropriate penile erection. Use of the drug is discontinued immediately and the primary care provider notified. Injection of a-adrenergic stimulants (eg, norepinephrine) may be helpful in treating priapism. In some cases, surgical intervention may be required. Venlafaxine may cause an increase in die blood pressure. A sustained increase in die blood pressure may indicate that die dosage of venlafaxine needs to be decreased. 

In summary, early evidence indicates that mirtazapine holds promise in the treatment of PTSD, but nefazodone, trazodone, and bupropion offer little benefit. 

Although trazodone has not received an FDA indication for use in children and adolescents, it has enjoyed some success in the treatment of disruptive behavior disorders in this population. An aggressive 15-year-old male inpatient was treated with trazodone at a dosage of 200 mg/day, which resulted in decreased disruptive behavior. Following discharge from the hospital, trazodone was discontinued and the patient s violent behavior resumed. Upon return to his previous dose of 200 mg, the aggressive behavior again remitted (Fras,... 

All SSRIs have an antipanic effect. Their advantages are limited adverse effects and lack of toxicity. Because of more acceptable adverse effect profiles, the SSRIs are usually the drugs of choice. Several studies consistently indicate that SSRIs such as fluoxetine, sertraline, paroxetine, fluvoxamine, as well as agents such as clomipramine and trazodone, all possess antipanic efficacy, although the last may be less effective than imipramine ( 24, 105, 106, 107, 108 and 109). 

Antidepressants. Although not specifically indicated to treat insomnia, antidepressant compounds are often used for their sedating properties, particularly when coexisting depression or anxiety are present. Newer antidepressants that often help with insomnia include trazodone (Desyrel) nefazodone (Serzone) mir-tazapine (Remeron) amytriptyline (Elavil) trim-ipramine (Surmontil) and doxepin (Sinequan). 

Clinical experience with trazodone has indicated unpredictable efficacy for depression though it has proved very useful as a hypnotic, sometimes being combined with MAOIs, which disturb sleep. 

Trazodone (150 mg/day) is indicated in the treatment of depression. Trazodone selectively inhibits serotonin reuptake in the brain, causes beta-receptor subsensitivity, and induces significant changes in serotonin-receptor binding with only a slight effect on alpha-adrenergic receptors. Also, trazodone potentiates the action of 5-hydroxytryp-tophan, the precursor of serotonin (see also Tables 5 through 7). 

Trazodone is extensively metabolized in the liver by N-dealkylation to its primary active metabolite, m-chlorophenylpiperazine (m-CPP), which subsequently undergoes aromatic hydroxylation to p-hydroxy-m-CPP (Fig. 21.23) (75). In vitro studies indicate that CYP3A4 is the major isoform involved in the production of m-CPP from trazodone (and CYP2D6 to a lesser extent). The p-hydroxy-m-CPP and oxotriazolopyridine-propionic acid (the major metabolite exoreted in urine) are conjugated with glucuronic acid. Less than 1 % of a dose is excreted unmetabolized. 

A study in 14 treatment-resistant depressed patients aged between 61 and 82 found that 7 showed eomplete improvement and 3 showed partial improvement, 3 to 21 days after lithium was added to treatment with the tricyclic or related antidepressants. Lithium adverse effects occurred in 6 patients 4 of whom stopped lithium as a result. One of them was successfully restarted at a lower dose. Tremor was the most frequent adverse effect, and reversible neurotoxicity with a stroke-like syndrome was the most severe. The antidepressants used were amitriptyline, doxepin, maprotiline and trazodone. A meta-analysis of 9 studies on the acute treatment of unipolar or bipolar depression indicated that the combined use of a mood stabiliser (lithium in 6 studies) and a tricyclic antidepressant was associated with an increased risk of switches into (hypo)mania, when compared with a mood stabiliser alone. It was suggested that monotherapy with a mood stabiliser should be tried to see if it is effective, before adding an antidepressant. Tricyclics were considered to be second-line antidepressants, with SSRIs the preferred choice. ... 

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