II. Indications

  1. Insomnia (as adjunct to SSRI)
  2. Impotence
    1. See Impotence Management for more effective agents

III. Mechanism

  1. Triazolopyridine derivative
  2. Unrelated to Tricyclic Antidepressants
  3. Phenylpiperazine Antidepressant (Serzone prototype)
  4. Serotonin Antagonist and Reuptake Inhibitor (SARI)
    1. Blocks 5-HT-2 postsynaptic receptor
    2. Low dose: Serotonin receptor Antagonist
    3. High dose: Serotonin Agonist
    4. Weaker than SSRIs as a Serotonin reuptake inhibitor

IV. Pharmacokinetics

  1. Serum Half Life: 4 to 9 hours
  2. Therapeutic plasma level: 800 to 1600

V. Efficacy: Major Depression

VI. Background

  1. Cost: $34 per month (generic)

VII. Dosing

  1. Sleep
    1. Dose: 25-100 mg PO qhs
    2. Average: 50 mg PO qhs
  2. Major Depression
    1. Start: 50 to 150 mg per day in divided doses
    2. Effective dose: 400 to 600 mg in divided doses

VIII. Adverse Effects

  1. Sedation
    1. Limits use as an Antidepressant
    2. Useful in Major Depression with Insomnia
  2. Priapism
    1. See Priapism Management
  3. Serotonin Syndrome
  4. Cardiac Arrhythmia
  5. Orthostatic Hypotension (Dizziness)
    1. Minimize by administering with food

IX. Drug Interaction

  1. Increased serum Digoxin level
  2. Increased Phenytoin level

X. Toxicity

XI. References

  1. Sundberg (1995) Depression Primary Care, PGM, p. 45-57

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Cost: Medications

trazodone (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
TRAZODONE 100 MG TABLET Generic $0.07 each
TRAZODONE 150 MG TABLET Generic $0.12 each
TRAZODONE 300 MG TABLET Generic $1.40 each
TRAZODONE 50 MG TABLET Generic $0.04 each