Desyrel (Trazodone): Uses, dosage, side effects, warnings & patient reviews

What is Desyrel (Trazodone)?

Desyrel is a prescription medication containing the active ingredient trazodone hydrochloride. It is classified as a serotonin antagonist and reuptake inhibitor (SARI). This unique mechanism means it works by both inhibiting the reuptake of serotonin (increasing its availability) and blocking certain serotonin receptors in the brain.

It is FDA-approved for the treatment of major depressive disorder (MDD). The therapeutic antidepressant effect for depression typically requires several weeks of consistent use. For a broader understanding of depression treatment, please refer to our caring guide to antidepressants.

At lower doses, trazodone is commonly used off-label under medical supervision for the treatment of insomnia due to its potent sedative effects, which occur much more rapidly than its antidepressant action.

Available Forms and Generic Status

Desyrel is available in tablet form in various strengths, including Desyrel 50 mg, Desyrel 100 mg, and Desyrel 150 mg. Generic trazodone is widely available and contains the identical active ingredient.

How to Take Desyrel

Administration of Desyrel must be precisely directed by a prescribing physician. The following are general guidelines.

Dosage and Administration

The dosage is highly individualized based on the condition being treated, patient response, and tolerance to side effects. For depression, treatment is usually initiated at a low dose, taken in divided doses daily, and gradually increased as needed and tolerated.

The tablets should be swallowed whole with a sufficient amount of water. Taking Desyrel shortly after a meal or light snack may help reduce the incidence of dizziness or lightheadedness.

Important Precautions

• Consistency is Key: Take this medication exactly as prescribed. Do not abruptly stop taking Desyrel, as this can lead to withdrawal symptoms. Any discontinuation should be managed by a doctor through a gradual dose reduction.
• Time to Effect: The full antidepressant effect may not be evident for 2 to 4 weeks. The medication should be taken consistently, even if immediate mood improvement is not noticed.
• Symptom Monitoring: Patients, families, and caregivers should monitor for any emergence or worsening of depression, suicidal thoughts or behavior, or unusual changes in mood or behavior, especially during the initial few months of treatment or after a dose change, and report these immediately to a healthcare provider.

Side Effects of Desyrel

Trazodone therapy is associated with a range of adverse effects, primarily related to its actions on the central nervous and cardiovascular systems.

What is Desyrel Used For?

Desyrel (trazodone) has defined medical applications, which include both FDA-approved indications and common off-label uses managed by physicians.

FDA-Approved Indication

Major Depressive Disorder (MDD): Desyrel is indicated for the treatment of MDD. Its efficacy in treating depression is based on its serotonergic activity. Improvement in depressive symptoms is not immediate and requires sustained administration.

Common Off-Label Use

Insomnia: Trazodone is frequently prescribed off-label at lower doses (e.g., 25-100 mg at bedtime) for the management of insomnia. This use is based on its potent sedative effect, which occurs due to its antihistaminic and alpha-adrenergic blocking properties. This application is not FDA-approved for the trazodone formulation marketed as Desyrel but represents a widespread clinical practice. Other sedating medications, such as quetiapine (Seroquel), may also be considered by physicians for similar purposes.

Important Limitations

• Desyrel is not approved for use in children and adolescents for depression due to an increased risk of suicidal thoughts and behaviors.
• It is not indicated as a monotherapy for bipolar disorder, as it may induce manic episodes.

Important Safety Concerns and Considerations

Suicidality and Antidepressant Drugs

Desyrel carries a Boxed Warning, the FDA’s most serious caution. Antidepressants may increase the risk of suicidal thinking and behavior in children, adolescents, and young adults (ages 18-24) during the initial treatment period. Patients of all ages must be monitored closely for clinical worsening, suicidality, or unusual changes in behavior, especially when starting therapy or changing the dose.

Priapism

Although rare, trazodone can cause priapism—a painful erection lasting more than 4 hours unrelated to sexual stimulation. This is a medical emergency requiring immediate intervention to prevent permanent damage to erectile tissue and potential long-term erectile dysfunction. Patients should be instructed to discontinue the drug and seek emergency care if this occurs.

Cardiovascular Effects

Trazodone can cause orthostatic hypotension (a sudden drop in blood pressure upon standing) and has been associated with cardiac arrhythmias, including ventricular ectopy and tachycardia. It can also prolong the QT interval in some patients. Caution is required in patients with pre-existing cardiovascular disease or those taking other QT-prolonging drugs.

Activation of Mania/Hypomania

In patients with bipolar disorder, treating a depressive episode with an antidepressant alone may precipitate a manic or hypomanic episode. Desyrel is not approved for use in treating bipolar depression and should generally be avoided unless used in combination with a mood stabilizer under psychiatric supervision.

Critical Warnings for Desyrel Use

Serotonin Syndrome

The concomitant use of Desyrel with other serotonergic drugs (including SSRIs, SNRIs, triptans, tramadol, lithium, and St. John’s Wort) increases the risk of serotonin syndrome, a potentially life-threatening condition. Symptoms include mental status changes, autonomic instability, neuromuscular abnormalities, and gastrointestinal symptoms. Combination therapy requires close monitoring and should only be undertaken with awareness of this risk.

CNS Depression

Desyrel produces dose-related CNS depression. When combined with other CNS depressants such as alcohol, sedatives, hypnotics, or opioid pain medications, the depressant effects are additive, increasing the risk of profound sedation, respiratory depression, coma, and death.

Screening for Bipolar Disorder

Prior to initiating treatment with an antidepressant, patients should be adequately screened for a personal or family history of bipolar disorder, mania, or hypomania. Desyrel is not indicated for treating bipolar depression.

Discontinuation Syndrome

Abrupt discontinuation of Desyrel after prolonged use may lead to withdrawal symptoms such as anxiety, agitation, insomnia, nausea, and flu-like symptoms. A gradual taper under medical supervision is recommended when discontinuing treatment.

Potential for Cognitive and Motor Impairment

As Desyrel can impair judgment, thinking, and motor skills, patients should be cautioned about performing tasks that require mental alertness until they are reasonably certain the medication does not adversely affect them.

Desyrel Dosage Information

Dosage must be individualized and initiated at the lowest possible level. The following table outlines general dosage ranges. The prescribing physician’s instructions must be followed precisely.

Important Administration Notes

• Dose Titration: For depression, the dose may be increased by 50 mg per day every 3 to 4 days based on response and tolerance.
• Divided Dosing: The total daily dose for depression is typically divided into two or more doses, with a larger portion often given at bedtime to utilize sedative effects.
• Elderly/Debilitated Patients: A lower starting dose (e.g., 25-50 mg at bedtime) is recommended, with gradual increases.
• Hepatic/Renal Impairment: Use with caution; lower doses and slower titration may be necessary.
• Missed Dose: If a dose is missed, it should be taken as soon as remembered unless it is close to the time for the next dose. Do not double the dose.

Drug Interactions with Desyrel

Desyrel (trazodone) interacts with many medications. The following table highlights significant interactions. A comprehensive review of all concomitant medications with a healthcare provider is mandatory.

Additional Information

Storage and Handling

Store Desyrel tablets at room temperature between 20°C to 25°C (68°F to 77°F), in a tightly closed container, and protect from light, moisture, and excessive heat. Keep all medications out of the reach of children and pets.

Overdose Information

Overdose of trazodone can be severe and potentially fatal. Symptoms may include excessive sedation, vomiting, respiratory depression, seizures, priapism, and cardiac arrhythmias. In case of suspected overdose, immediate medical attention must be sought, or a poison control center contacted.

Reporting Side Effects

Patients and healthcare professionals are encouraged to report negative side effects of prescription drugs to the FDA MedWatch program. Reporting helps the FDA monitor drug safety and identify new risks.

References and Medical Sources

The information on this page is compiled from authoritative medical sources and prescribing information.

1. U.S. Food and Drug Administration (FDA). Desyrel (trazodone hydrochloride) Tablets Prescribing Information. [Revised 2017]. https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/018207s032lbl.pdf
2. MedlinePlus. Trazodone. U.S. National Library of Medicine; [Updated 2022]. https://medlineplus.gov/druginfo/meds/a681038.html
3. American Psychiatric Association. Practice Guideline for the Treatment of Patients with Major Depressive Disorder, Third Edition. 2010. [Amended 2015].
4. Drugs.com. Trazodone Professional Monograph. Drugs.com; [Updated 2024]. https://www.drugs.com/monograph/trazodone.html

Disclaimer: The information on this site is provided for informational purposes only and is not medical advice. It does not replace professional medical consultation, diagnosis, or treatment. Do not self-medicate based on the information presented on this site. Always consult with a doctor or other qualified healthcare professional before making any decisions about your health.