Īn extended-release oral tablet formulation at doses of 150 mg and 300 mg is also available. Trazodone is provided as the hydrochloride salt and is available in the form of 50 mg, 100 mg, 150 mg, and 300 mg oral tablets. Trazodone is often used in combination with other antidepressants such as selective serotonin reuptake inhibitors in order to augment their antidepressant and anxiolytic effects and to reduce side effects such as sexual dysfunction, anxiety, and insomnia. The American Academy of Sleep Medicine's 2017 clinical practice guidelines recommended against the use of trazodone in the treatment of insomnia due to inadequate evidence and due to harms potentially outweighing benefits. Higher doses of 200 to 600 mg/day have also been studied. Trazodone is used at low doses in the range of 25 to 150 mg/day for insomnia. Quality safety data on use of trazodone as a sleep aid are currently lacking. The benefits of trazodone for insomnia must be weighed against potential adverse effects such as morning grogginess, daytime sleepiness, cognitive and motor impairment, and postural hypotension, among others. There is no evidence available at present to inform long-term use of trazodone in the treatment of insomnia. The quality of evidence of trazodone for short-term treatment of insomnia was rated as low to moderate. It appears to increase deep sleep, in contrast to certain other hypnotics. Conversely, it does not appear to affect sleep onset, total sleep time, time awake after sleep onset, or sleep efficiency. Trazodone slightly improves subjective sleep quality ( SMD = –0.34 to –0.41) and reduces number of nighttime awakenings ( MD = –0.31, SMD = –0.51). Systematic reviews and meta-analyses published in the late 2010s, including a Cochrane review, found low-dose trazodone to be an effective medication for short-term treatment of insomnia both in depressed and non-depressed people. Trazodone was the second-most prescribed agent for insomnia in the early 2000s, though most studies of trazodone for treatment of sleep disturbances have been in depressed individuals. It may also be used to treat antidepressant-related insomnia. Low-dose trazodone is used off-label in the treatment of insomnia and is considered to be effective and safe for this indication. Trazodone is often used as an alternative to benzodiazepines in the treatment of anxiety disorders. Besides anxiety, trazodone has been used to treat sleep disturbances and nightmares in PTSD. However, use of trazodone in anxiety disorders is off-label and evidence of its effectiveness for these indications is variable and limited. Trazodone is often used in the treatment of anxiety disorders such as generalized anxiety disorder, panic disorder, post-traumatic stress disorder (PTSD), and obsessive–compulsive disorder (OCD). Trazodone is usually administered multiple times per day, but once-daily administration may be similarly effective. Higher doses up to 600 mg/day have been used in more severe cases of depression, for instance in hospitalized patients. Lower doses have also been used to augment other antidepressants, or when initiating therapy. Trazodone is usually used at a dosage of 150 to 300 mg/day for the treatment of depression. Still, trazodone is often helpful for geriatric patients with depression who have severe agitation and insomnia. However, a side effect of trazodone, orthostatic hypotension, which may cause dizziness and increase the risk of falling, can have devastating consequences for elderly patients thus, this side effect, along with sedation, often makes trazodone less acceptable for this population, compared with newer compounds that share its lack of anticholinergic activity but not the rest of its side-effect profile. Three double-blind studies reported trazodone has antidepressant efficacy similar to that of other antidepressants in geriatric patients. īecause trazodone has minimal anticholinergic activity, it was especially welcomed as a treatment for geriatric patients with depression when it first became available. Also, trazodone showed anxiolytic properties, low cardiotoxicity, and relatively mild side effects. Data from open and double-blind trials suggest the antidepressant efficacy of trazodone is comparable to that of amitriptyline, doxepin, and mianserin. The primary use of trazodone is the treatment of unipolar major depression with or without anxiety.
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