Trazodone side effects and how to avoid them

Creator: SingleCare
Published: 2022-08-09T11:32:14-04:00

Trazodone side effects include weight gain, sexual dysfunction, and urinary incontinence

By SingleCare Team | Aug. 9, 2022 Medically reviewed by Kristi C. Torres, Pharm.D.

People are prescribed trazodone hydrochloride to help with depression or anxiety. Trazodone is an older generation antidepressant that is approved to treat major depressive disorder. It has been used to help with anxiety as well, but most commonly is used off-label to take advantage of its tendency to cause sedation and help with insomnia. It belongs to a group of drugs called serotonin antagonist and reuptake inhibitors, drugs that alter brain chemistry to permit greater control over mood. Trazodone affects the body in the same way, so side effects are similar to its better-known cousins like Paxil (paroxetine) and Prozac (fluoxetine). Trazodone is only available as a generic but used to be sold under the brand names Desyrel and Oleptro.

Common side effects of trazodone

The most commonly experienced side effect of trazodone is drowsiness, affecting almost one in four people taking the drug. About one in five people have reported dizziness or high blood pressure. Other common side effects include:

Dry mouth
Nervousness
Tiredness
Nausea or vomiting
Headache
Constipation
Low blood pressure
Aches and pains
Problems with coordination
Abdominal pain
Blurred vision
Confusion
Problems with concentration
Tremors
Red and itchy eyes
Nasal or sinus congestion
Edema
Skin reactions
Disorientation
Feeling bad
Fainting
Muscle pain
Trouble sleeping
Sexual dysfunction
Weight changes

Serious side effects of trazodone

The most serious adverse effects of trazodone are relatively rare and include:

Suicidal thoughts and behaviors
Worsening of depression
Serotonin syndrome
High blood pressure
Orthostatic hypotension
Heart attack
Heart rhythm problems
Angle-closure glaucoma
Dangerously low sodium levels
Seizures
Painful erections (priapism)
Bleeding
Withdrawal
Severe allergic reactions

Weight gain

In clinical trials, approximately one in a hundred people taking trazodone experienced weight gain. Later research indicates the incidence may be as high as 5%, although research suggests that as much as 6% of patients experience weight loss when taking trazodone. No matter what the case, however, always get medical advice whenever weight goes up or down unintentionally when taking a drug. A nutritionist’s advice may be needed.

Sexual dysfunction

Nearly every person who takes an SSRI will experience some reduction in genital sensitivity. For this reason, SSRIs are frequently used off-label to treat premature ejaculation. Impotence, however, is a rare problem in people taking trazodone, occurring in less than 2% of participants in the initial clinical trials. Research indicates that around 1.5% of patients will experience a decrease in sexual desire and less than 1% will have problems with orgasms because of genital numbing. The good news is that most people will experience a return of genital sensitivity, sexual desire, and sexual function when trazodone is stopped. If there are problems with sexual function, get medical advice from the prescriber.

Urinary incontinence

People taking trazodone only rarely experience urinary incontinence as a side effect. It is a reported side effect, but the incidence is between 0% and 1%, depending on the study. If urinary incontinence is a problem, keep in mind that there may be other causes besides trazodone. Talk to a healthcare provider about the best way to proceed.

Trazodone side effects for females

Are women more likely to experience trazodone side effects than men? This question hasn’t been answered. The best that can be said is that people will have individual responses to trazodone. Any adverse effects have to be balanced against the good the drug does, and SSRIs seem to benefit women more than men, though we don’t know why.

How soon do trazodone side effects start?

The serotonin effects of trazodone occur within half an hour of taking a dose, so side effects such as drowsiness, dry mouth, dizziness, trouble sleeping, nausea, urinary incontinence, blurred vision, genital numbing, and similar side effects are sometimes experienced early or even after the first dose. Other side effects, such as sexual dysfunction or weight changes, may develop and worsen over time. Among serious side effects, heart problems can occur early and unexpectedly, particularly changes in the heart’s rhythm. Suicidality and worsening of depression may take longer to manifest but should be monitored for as soon as therapy is started.

How long do trazodone side effects last?

Many of the side effects of trazodone will moderate as time goes by. Trazodone is intended as a time-limited treatment, so most side effects, including sexual dysfunction, can be expected to resolve shortly after the drug is discontinued. However, some problems may take a while to get better, such as weight changes or severe heart problems.

What are the long-term side effects of trazodone?

Even when trazodone is discontinued, people may experience long-term problems from taking the drug. In rare cases, sexual dysfunction persists for a long time after an SSRI is discontinued, a medical condition known as post-SSRI sexual dysfunction. Some serious side effects, such as heart attack, may entail lifelong problems.

Trazodone contraindications

Because of certain medical conditions, some people cannot safely take trazodone. These include anyone allergic to the drug or who has recently experienced a heart attack.

The FDA has approved trazodone only for use in adults. Safety and efficacy have not been established in patients under 18 years of age. However, some healthcare professionals may prescribe it off-label to children and adolescents. If so, they will need to be closely monitored for worsening depression and suicidality. Trazodone is used with caution in seniors, but there is no evidence of any increased risk of side effects.

There is no evidence that trazodone is unsafe for women who are pregnant or breastfeeding. Although trazodone does show up in breast milk, there is no evidence that it will harm a nursing baby. Major depressive episodes can be a risk during pregnancy, and the use of trazodone to any antidepressant must consider the benefits to the health of the mother against the unknown risk to the baby.

Trazodone warnings

As with all prescription drugs, trazodone has risks. People need to be aware of these and, in some cases, be more closely monitored for side effects when taking this drug.

Suicidality

The FDA has put a black box warning on trazodone’s drug information sheet warning about the risk of suicidal thoughts and behaviors, particularly in children and young adults. These patients will need to be monitored closely for behavior changes.

Abuse and dependence

The U.S. Food and Drug Administration (FDA) does not consider trazodone to be a drug with the potential for abuse or physical dependence.

Overdose

An overdose of trazodone will require emergency medical care. Depending on the dose, it can cause severe problems that could be life-threatening, particularly when taken with alcohol or sedatives. The most common symptoms of a trazodone overdose are drowsiness or vomiting.

Withdrawal

The sudden discontinuation of trazodone or any other SSRI can cause withdrawal symptoms such as excessive sweating, nausea, irritability, anxiety, agitation, dizziness, confusion, headache, mood swings, ringing in the ears, and even seizures. When trazodone therapy needs to stop, the doses will gradually decrease over a period of weeks.

Restrictions

Trazodone could worsen some medical conditions. People with these medical conditions can take trazodone, but they will need to be monitored more closely for problems. These include:

Heart disease or other heart problems
Electrolyte imbalances
Bipolar disorder
Bleeding problems
Seizure disorders
Narrow angles or a history of angle-closure glaucoma
Dehydration
Liver disease
Renal impairment

Trazodone interactions

Trazodone can also cause problems when combined with other drugs. In some cases, these issues can be risky enough that healthcare professionals never prescribe trazodone with these other drugs. At the top of the prohibited list are monoamine oxidase inhibitors (MAOIs), a small family of drugs that treat depression or Parkinson’s disease. Allow for at least 14 days to lapse between stopping MAOI treatment and initiating trazodone. Trazodone is also never combined with the antipsychotic medications pimozide or thioridazine, or the HIV/AIDS drug saquinavir.

Because of the risk of serotonin syndrome, a hazardous elevation of serotonin in the brain, healthcare professionals are cautious about combining trazodone with other serotonin-increasing drugs including other antidepressant medications, migraine drugs (triptans), antipsychotics, opioids, anxiety medications, anticonvulsants, anti-nausea drugs, lithium, and some common over-the-counter supplements such as St. John’s wort or tryptophan.

When some drugs are combined with trazodone, the risk of serious adverse effects increases. Combining these drugs will require closer monitoring and vigilance. These include:

Blood thinners
NSAIDs
Sedatives and other central nervous system (CNS) depressants
Drugs that affect heart rhythm
Drugs that speed up or slow down the body’s metabolism of trazodone.

How to avoid trazodone side effects

Most people taking trazodone will experience transient side effects. Not all are avoidable, but there are a few ways to minimize problems.

1. Take trazodone as directed

Follow the instructions given by the prescribing healthcare provider. Most people will take a 50–100 mg dose two or three times daily with food. At this frequency, it’s easy to miss a dose or take an extra dose, so it helps to use an alarm or app to make sure doses are taken correctly. If a dose is missed, take it as soon as it’s remembered. If it’s nearly time to take the next dose, skip the missed dose and take the next dose as scheduled.

2. Inform the prescriber about all medical conditions

The first and best way to avoid problems taking trazodone is to make sure the prescribing healthcare provider has a complete medical history before the first pill is taken. Don’t leave anything out, but make sure that the prescriber knows about:

Suicidal thoughts
Heart disease
Heart rhythm problems, particularly a problem called QT prolongation
A history of bleeding or blood clotting problems
A history of seizures
Dehydration
Low sodium
Glaucoma
Narrow angles in the eye
Mania or bipolar disorder
Liver problems
Pregnancy or pregnancy plans
Breastfeeding or breastfeeding plans

3. Tell the doctor about all medications being taken

Drug interactions are another source of side effects when taking trazodone, so tell the prescribing healthcare professional about all prescription drugs, over-the-counter medications, and supplements being taken, especially:

MAO inhibitors
Antidepressant medications including other SSRIs, SNRIs, and tricyclic antidepressants
Medicines that treat anxiety, schizophrenia, or other mental health conditions
Seizure medications
Migraine medications called triptans
Opioids
Amphetamines or ADHD medications
Heart rate medications
Blood thinners such as warfarin
NSAIDs
Over-the-counter supplements such as St. John’s wort or tryptophan

4. Do not quit taking trazodone

If there are problems, talk to a healthcare professional before quitting trazodone. Sudden discontinuation—particularly after months of treatment—could lead to unpleasant withdrawal symptoms.

5. Avoid alcohol

Alcohol will worsen many of the sedative effects of trazodone such as sleepiness, fatigue, and dizziness.

6. Be careful about driving and other risky activities

Speaking of sedative effects, trazodone could make driving and other risky activities more dangerous. Healthcare professionals advise that these activities be put on hold for a few days when first taking trazodone. This allows people to determine if they can drive or perform other activities safely.

7. Avoid NSAIDs

To avoid abdominal problems and possible bleeding events, avoid NSAID pain relievers such as aspirin or ibuprofen. If possible, use acetaminophen instead.

8. Eat a healthy diet

To avoid or minimize weight changes, eat a healthy diet. If weight goes up or down unintentionally, talk to a dietitian or nutritionist.

How to treat side effects of trazodone

Most people will only experience minor problems taking trazodone. The most common is sleepiness and dizziness due to the sedative effects of the drug. Many of these transient side effects get better over time as the body adapts to the drug. Some can be managed by making simple lifestyle changes. Others might require medical attention.

Sleepiness, dizziness, lightheadedness. These side effects can’t always be avoided but can be managed by removing obstacles in the house that can cause falls, moving carefully, and modifying daily activities.
Weight changes. If weight goes up or down, talk to a dietitian or nutritionist about the best diet to counter these weight changes.
Worsening depression or suicidal thoughts

Immediately talk to the prescriber or another mental health professional. Trazodone may need to be stopped.

Signs of heart problems. Immediately get medical help for any sign of heart problems such as racing heartbeats, fluttering heartbeats, slowed heart rate, shortness of breath, or fainting.
Low sodium. Call a healthcare professional at any sign of low sodium such as confusion, headache, weakness, or coordination problems.
Serotonin syndrome. A potentially severe side effect, serotonin syndrome does require emergency medical help. The signs are psychiatric and neurological: agitation, restlessness, hallucinations, tremors, stiff muscles, and problems with coordination. The usual treatment is to stop taking drugs like trazodone that raise serotonin.