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Generic Name: Trazodone
Brand Names: Desyrel, Beneficat, Deprax, Desirel, Molipaxin, Thombran, Trazorel, Trialodine, Trittico
How does it work?
Desyrel tablets, capsules and liquid contain the active ingredient trazodone, which is a type of medicine called an antidepressant. Antidepressants act on nerve cells in the brain.
In the brain there are numerous different chemical compounds called neurotransmitters. These act as chemical messengers between the nerve cells. Serotonin and noradrenaline are neurotransmitters and they have various functions that we know of.
When serotonin and noradrenaline are released from nerve cells in the brain they act to lighten mood. When they are reabsorbed into the nerve cells, they no longer have an effect on mood. It is thought that when depression occurs, there may be a decreased amount of serotonin and noradrenaline released from nerve cells in the brain.
Trazodone works by preventing serotonin from being reabsorbed back into the nerve cells in the brain. It may also mimic the mood-lightening effect of released serotonin and enhance a very small degree of noradrenaline release from nerve cells in the brain. This helps enhance and prolong the mood-lightening effect of any released noradrenaline and serotonin. In this way, trazodone helps relieve depression.
Trazodone can cause drowsiness. This means it may be useful in treating depression in people who are also anxious and agitated, or who are suffering from disturbances in sleep.
Trazodone also acts to relieve anxiety and is therefore useful in the treatment of depression that is accompanied by anxiety. It may also be used in the long-term treatment anxiety disorders where other medication is considered inappropriate.
It may take between one to four weeks for the full benefits of this medicine to appear, so it is very important that you keep taking it, even if it doesn't seem to make much difference at first. If you feel your depression has got worse, or if you have any distressing thoughts or feelings in these first few weeks, then you should talk to your doctor.
What is it used for?
• Depressive illness, including depression accompanied by anxiety.
• Depression and other psychiatric illnesses are associated with an increased risk of suicidal thoughts, self-harm, and suicide. You should be aware that this medicine may not start to make you feel better for at least a week and may not have its full effect for up to four weeks. However, it is important that you keep taking it in order for it to work properly and for you to feel better. If you feel your depression has got worse, or if you have any distressing thoughts or feelings, particularly about suicide or harming yourself in these first few weeks, or indeed at any point during treatment or after stopping treatment, then it is very important to talk to your doctor.
• This medicine may cause drowsiness and could reduce your ability to drive or operate machinery safely. Do not drive or operate machinery until you know how this medicine affects you and you are sure it won't affect your performance.
• It is recommended that you avoid drinking alcohol while taking this medicine because it may enhance drowsiness.
• This medicine can occasionally cause your blood pressure to drop when you move from a lying down or sitting position to sitting or standing, especially when you first start taking the medicine. This may make you feel dizzy or unsteady. To avoid this try getting up slowly. If you do feel dizzy, sit or lie down until the symptoms pass.
• Antidepressants may cause the amount of sodium in the blood to drop - a condition called hyponatraemia. This can cause symptoms such as drowsiness, confusion, muscle twitching or convulsions. Elderly people may be particularly susceptible to this effect. You should consult your doctor if you develop any of these symptoms while taking this medicine so that your blood sodium level can be checked if necessary.
• You should not suddenly stop taking this medicine unless otherwise directed by your doctor, as this may cause withdrawal symptoms such as nausea, vomiting, loss of appetite, headache, giddiness, chills, insomnia, restlessness or anxiety. Withdrawal symptoms are temporary and are not due to addiction or dependence on the medicine. They can usually be avoided by stopping the medicine gradually, usually over a period of weeks or months, depending on your individual situation. Follow the instructions given by your doctor when it is time to stop treatment with this medicine.
• During long-term treatment with this medicine your doctor may want to monitor your heart and liver function and take blood tests to monitor the levels of blood cells in your blood. You should let your doctor know if you experience symptoms such as a fever or sore throat while you are taking this medicine.
• If you get an erection that lasts longer than four hours (priapism) while taking this medicine, you should consult a doctor immediately. Treatment of this condition should not be delayed more than six hours, as this can cause damage to the erectile tissue in the penis and irreversible erectile dysfunction.
Use with caution in
• Elderly people.
• Young adults.
• People with a history of suicidal behaviour or thoughts.
• Severe liver disease.
• Severe kidney disease.
• Severe heart disease.
• Irregular heart beats (arrhythmias).
Not to be used in
• People who have taken a monoamine oxidase inhibitor antidepressant (MAOI) in the last two weeks.
• This medicine is not recommended for children.
This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy.
If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.
Pregnancy and breastfeeding
Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.
• The safety of this medicine for use during pregnancy has not been established. It is not recommended for pregnant women, particularly in the first and third trimesters, unless considered essential by your doctor and the benefits to the mother outweigh the potential risks to the unborn baby. Seek medical advice from your doctor.
• This medicine may pass into breast milk. It should be used with caution in mothers who are breastfeeding, and only if the potential benefits outweigh any risks to the nursing infant. Seek medical advice from your doctor.
• Take this medication with or after food.
• This medication may cause drowsiness. If affected do not drive or operate machinery. Avoid alcoholic drink.
Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Just because a side effect is stated here does not mean that all people using this medicine will experience that or any side effect.
• Disturbances of the gut such as diarrhoea, constipation, nausea, vomiting.
• Feeling weak.
• Weight loss.
• Dry mouth.
• A drop in blood pressure that occurs when going from lying down to sitting or standing, which results in dizziness and lightheadedness (postural hypotension).
• Increase or decrease in heart rate.
• Fluid retention (oedema).
• Blurred vision.
• Skin rash.
• Disturbances in the normal numbers of blood cells in the blood.
• Liver problems, eg jaundice (yellowing of the skin and eyes).
• Persistent painful erection of the penis (priapism - see warning above).
• Abnormal heart beats (arrhythmias).
The side effects listed above may not include all of the side effects reported by the drug's manufacturer.
For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.
How can this medicine affect other medicines?
It is important to tell your doctor or pharmacist what medicines you are already taking, including those bought without a prescription and herbal medicines, before you start treatment with this medicine. Similarly, check with your doctor or pharmacist before taking any new medicines while taking this one, to ensure that the combination is safe.
Trazodone should not be taken in combination with a monoamine oxidase inhibitor antidepressant (MAOI), eg phenelzine, tranylcypromine, isocarboxazid, or moclobemide. Treatment with trazodone should not be started until at least two weeks after stopping an MAOI. Conversely, an MAOI should not be started until a week after stopping trazodone.
There may be an increased risk of drowsiness if other medicines that can cause drowsiness, such as the following, are taken in combination with trazodone:
• sedating antihistamines, eg chlorphenamine, promethazine
• benzodiazepines, eg diazepam, temazepam
• sleeping tablets, eg zopiclone
• strong opioid painkillers, such as morphine, codeine.
Trazodone may increase the blood levels of digoxin and phenytoin.
Sibutramine is not recommended for use in combination with this medicine.