Trazodone, sold under the brand name Desyrel, belongs to the drug class serotonin modulators. These medications are intended for the treatment of major depressive disorder. Moreover, when it comes to this drug, toxicity is possible. Although Desyrel toxicity is a rare type of drug toxicity, this can lead to fatality. According to the study of medical doctors from the USA, 9 out of 88 patients who overdosed on Desyrel died and this risk can be increased when people take it with alcohol. Furthermore, this antidepressant medication cannot produce feelings of euphoria, so, toxicity is usually consequent to accidental ingestion or an attempt to expedite relief from depressive symptoms by taking too much of the drug. This separates it from the majority of psychoactive drugs, where toxicities result from addiction or recreational use.
In this article, information about the risk factors for Trazodone overdose, signs and symptoms of OD, Desyrel fatality, and how to treat this toxicity will be provided.
Can One Overdose On Trazodone?
Most people who use this drug have had to ask their doctors at some point whether they can overdose on Trazodone. It is possible to overdose on this antidepressant. However, this is not so common, as, according to the American Association of Poison Control Centers, there is only a 1% rate for people to overdose on this drug. Additionally, the Desyrel drug class, with other different brand names including Oleptro, Molipaxin, and Trazorel has no recreational value, so toxicity rarely results from addiction, abuse, or accidental ingestion. An overdose may, however, result from attempting to cause harm to the health and commit suicide with Desyrel.
Take note that the maximum dose of Trazodone for the treatment of depression is 400 mg per day in divided doses and the maximum dose of Trazodone for insomnia is 25 mg per day. So, any amount beyond the recommended dose for this drug may already cause toxicity. The range of toxicities varies: The trazodone overdose amount of up to 2-3 g may cause respiratory failure and a Trazodone overdose amount of 4-5 g may cause severe CNS depression and coma. Much lower doses produce toxic symptoms when combined with other drugs. If any of these signs are observed, it is important to seek immediate care or help in order to avoid dangerous health events.
Risk Factors For Trazodone Overdose
Take note that for all medications, accidental and intentional consumption are not the only factors that can contribute to OD. In terms of Desyrel, drug abuse, personal factors, polypharmacy, and impaired liver or kidney diseases greatly contribute to Trazodone overdose. In this section, these factors will be elaborated on.
Abuse
Desyrel has no recreational value, and there are no Desyrel addictive effects. Therefore, it is not a drug of abuse, even though it may cause discomforting withdrawal symptoms and psychological addiction to the drug. So, how can the abuse of Desyrel be related to toxicity? When people ingest more significant amounts of the drug than the maximum dose of Trazodone allowed, or when they co-administer the medication with other depressants or drugs that can alter its metabolism, that is already considered misuse and this may cause toxic effects. For this reason, it is a must to strictly comply with the doctor’s medical instructions and policy when using the drug to avoid the occurrence of toxicity.
Personal Factors
Age, body weight, and the metabolism of people using Desyrel affect how long it stays in the system. According to the study of medical doctors from Spain, patients ages 18-63 years old who intentionally consumed around 30 mg/L of Trazodone experienced mild and nonfatal toxicity. This means that patients ages below 18 years old and patients above 63 years old are more at risk of experiencing severe and fatal Desyrel OD. Moreover, all age groups must use this drug with care, as this drug may cause weight gain and loss.
Co-Administration with Other Drugs
Desyrel drug interactions are a common risk factor for toxicity. Mixing Desyrel with other psychoactive substances may prolong its stay in the blood. Some of these include alcohol, opiates, and antihistamines such as Diphenhydramine. For instance, Desyrel and alcohol death results from the interaction between both drugs: alcohol prolongs Desyrel’s stay in the system, increasing the risk of toxicity.
Also, Desyrel is metabolized in the liver by the enzymes CYP3A4. Therefore, co-administration with drugs that inhibit the function of these enzymes may cause Desyrel to accumulate in the body. Eventually, this will lead to an increased risk of toxicity. Examples of these CYP3A4 inhibitors include Ketoconazole, Clarithromycin, and Itraconazole. For this reason, every healthcare provider, including pharmacists, must make a policy about the proper dispensing of these types of drugs.
Lastly, take note that Desyrel is a serotonin modulator. This means that it affects the levels of serotonin in the brain. So, when it is combined with other medications that increase the levels of serotonin, such as selective serotonin reuptake inhibitors (SSRIs), a condition called serotonin syndrome may occur. According to medical doctors from Minnesota, this condition will cause too much serotonin accumulation in the body and this is associated with Trazodone overdose.
Impaired Liver or Kidney Function
As mentioned above, the liver is the organ that is responsible for the metabolism of Desyrel. Aside from this organ, the kidney also plays a big role when it comes to Desyrel toxicity as this organ is responsible for 70-75% excretion of the drug. In simple words, the liver degrades Desyrel, and the kidney excretes its metabolites. If the liver’s capacity to metabolize Desyrel or the kidney’s excretory function is impaired, the drug may accumulate in the system, increasing the risk of toxic Desyrel side effects even from a small dose.
Can one overdose on Trazodone and die? Yes, one can die from an OD of this drug and that is why care and caution with the use of the drug are important. However, this is not so common.
Signs And Symptoms Of Desyrel Overdose
There are many signs and symptoms of Trazodone overdose which every patient using the medication must know. Since drug toxicity may also be caused by unintentional ingestion, being able to identify the following signs and symptoms below will be of great help in preventing fatal health events. According to medical professionals from Tucson, USA, the most common sign of Desyrel OD is severe hypotension.
Furthermore, Other Signs and Symptoms of Od Include the Following:
- Drowsiness
- Insomnia
- Lightheadedness
- Poor coordination
- Tremors
- Seizures
- Chronic headaches
- Shortness of breath
- Apnea (intermittent cessation of breathing)
- Chest pain
- Syncope (loss of consciousness)
According to the study of medical doctors from California, one of the fatal signs of Trazodone overdose is abnormal heart rhythms or arrhythmias. Patients who are using this medication and are experiencing changes in heart rhythms are advised to seek immediate care as soon as possible in order to avoid dangerous health events.
Trazodone Overdose Death
Trazodone overdose death is more likely when it is combined with other central nervous system depressants than when used alone. How the drug causes death is better understood when one knows how it works. It reduces the reuptake of serotonin in the nerves of the brain, thereby increasing its concentration in the brain. This increases the transmission of excitatory impulses in the brain.
One of the significant causes of death from its toxicity is serotonin syndrome. Although rare, serotonin syndrome is a life-threatening condition associated with the use of two or more drugs that increase serotonin concentration in the brain. When serotonin becomes too much in the brain, it causes high fevers, muscle rigidity, abnormal heart rhythm, and seizures, which may lead to death.
There are a few cases of deaths from ingesting Trazodone alone. In many of these cases, the individuals deliberately ingested large amounts to harm themselves. In one report, a 37-year-old woman ingested a Trazodone overdose amount of 6.45 g in a suicidal attempt. The patient developed seizures and severe cerebral edema, which led to her death.
Treatment Of Desyrel Overdose
As with most psychoactive drug toxicities, the treatment for Trazodone toxicity begins at the site of the incident. There is no Trazodone antidote. Therefore, time is the best bet in recovering from its toxic effects.
Ensure Emergency Help Is Contacted as Fast as Possible:
- In the emergency room, Trazodone overdose treatment is mostly symptom-specific. Doctors may also administer activated charcoal, which binds to the drug in the stomach, limiting the amount absorbed in the gut.
- The doctors may pass a long tube through the mouth to the stomach to extract the ingested content, which includes the drug. This procedure is called gastric lavage.
- Doctors will also set up intravenous access for the patient, to administer intravenous fluids to normalize the blood pressure. According to the study of medical doctors from Charleston, USA, management of Trazodone overdose is generally supportive. However, for patients experiencing arrhythmia, using a lipid emulsion therapy can terminate this sign of toxicity.
- If the patient has difficulty breathing, doctors may need to provide mechanical ventilation with oxygen administration to support the patient’s breathing and ensure oxygen supply to the tissues is optimal.
To prevent an overdose, ensure to take doses prescribed by the doctor and to check with the doctor before using any other drug with it. Increasing the dosage without the doctor’s prescription may be a red flag for developing an addiction. Contact the rehabilitation facility and get the consultation whether it is time to seek help. The sooner the drug abuse treatment is initiated, the more effective it will be.
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Published on: April 1st, 2019
Updated on: December 16th, 2021
About Author
Nena Messina, Ph.D.
Nena Messina is a specialist in drug-related domestic violence. She devoted her life to the study of the connection between crime, mental health, and substance abuse. Apart from her work as management at addiction center, Nena regularly takes part in the educational program as a lecturer.
Medically Reviewed by
Michael Espelin APRN
8 years of nursing experience in wide variety of behavioral and addition settings that include adult inpatient and outpatient mental health services with substance use disorders, and geriatric long-term care and hospice care. He has a particular interest in psychopharmacology, nutritional psychiatry, and alternative treatment options involving particular vitamins, dietary supplements, and administering auricular acupuncture.
FAQs
Trazodone Overdose: Signs, Symptoms, And Risks Of Overdose? ›
Symptoms can range from shivering and diarrhea to muscle rigidity, fever, and seizures. Severe cases of serotonin syndrome can be life-threatening if not properly managed.
What do you give for a trazodone overdose? ›Management of trazodone overdose generally is supportive. Cardiac monitoring is required, and serial EKGs can assist in monitoring conduction intervals. If patients present within a one-hour window, activated charcoal can be considered [2].
What is a severe reaction to trazodone? ›Serious side effects
you have difficulty pooing (constipation) or you're unable to pee. you are bruising more easily than usual or have unexplained bruising. you get more infections than usual, such as a sore throat or skin infections. you have a fast, slow or abnormal heartbeat.
If you take too much trazodone, you may experience a drop in blood pressure, which can cause dizziness or fainting. An overdose of trazodone can be fatal.
Does trazodone have life threatening side effects? ›- chest pain.
- fast, pounding, or irregular heartbeat.
- loss of consciousness (coma)
- fever, sweating, confusion, fast or irregular heartbeat, and severe muscle stiffness or twitching, agitation, hallucinations, loss of coordination, nausea, vomiting, or diarrhea.
- fainting.
- seizures.
- shortness of breath.
Adults—At first, 150 milligrams (mg) per day, given in divided doses. Your doctor may adjust your dose as needed. However, the dose is usually not more than 400 mg per day. Children—Use and dose must be determined by your doctor.
What happens when someone overdose on antidepressants? ›People who overdose on antidepressants may experience mild to severe symptoms, depending on how much they took and whether they mixed them with any other substances. Usually, common antidepressant overdose side effects include: Nausea and/or vomiting. Dilated pupils.
Does trazodone cause organ damage? ›Trazodone therapy can be associated with transient, usually asymptomatic elevations in serum aminotransferase levels and has been linked to rare instances of clinically apparent acute liver injury.
What drugs Cannot be taken with trazodone? ›Do not use trazodone with buspirone (Buspar®), fentanyl (Abstral®, Duragesic®), lithium (Eskalith®, Lithobid®), tryptophan, St. John's wort, or some pain or migraine medicines (eg, sumatriptan, tramadol, Frova®, Maxalt®, Relpax®, Zomig®).
Can trazodone cause psychosis? ›One depressive patient has been reported to develop psychosis following trazodone administration at a dose of 300 mg/day. The patient's psychotic symptoms included auditory hallucinations with threatening voices, agitation, stupor, negativism, and delusions.
Is it bad to take 300 mg of trazodone? ›
For anxiety, the usual dose is 75mg daily. Your dose may go up or down depending on how it affects you. Your doctor may prescribe up to 300mg a day for anxiety, or more for depression, if you need a stronger dose.
Is 200mg of Trazadone bad? ›Doctors often recommend a daily dose of 150 mg of trazodone for depression treatment. This amount can be increased to upward of 600 mg if necessary. Much lower doses are used to treat insomnia. As such, any amount exceeding 600 mg in 24 hours is considered an overdose.
What are signs of serotonin syndrome? ›- Agitation or restlessness.
- Insomnia.
- Confusion.
- Rapid heart rate and high blood pressure.
- Dilated pupils.
- Loss of muscle coordination or twitching muscles.
- High blood pressure.
- Muscle rigidity.
Trazodone reduces levels of neurotransmitters associated with arousal effects, such as serotonin, noradrenaline, dopamine, acetylcholine, and histamine. Low-dose trazodone use exerts a sedative effect for sleep through antagonism of 5-HT-2A receptor, H1 receptor, and alpha-1-adrenergic receptors.
Does trazodone affect your breathing? ›First, trazodone may lead to reduced arousals, which themselves may be destabilizing for control of breathing (9, 32).
How long does it take for trazodone to kick in? ›Trazodone can take 1 to 2 weeks to start to work, and it can be 4 to 6 weeks before you feel the full benefit. Give the medicine at least 6 weeks to work. Some people feel worse during the first few weeks of treatment before they begin to feel better.
What's the half life of trazodone? ›Trazodone has biphasic elimination, with a redistribution half-life of about one hour and an elimination half-life of 10-12 hours. Trazodone is nearly completely metabolized hepatically by hydroxylation and oxidation to metabolites that are probably inactive.
How long does it take trazodone to kick in for sleep? ›Patients who take the drug for a sleep disorder can experience the sedative effects within 30 minutes, depending on the type used. Patients who take the drug as an antidepressant may not notice symptom relief for one to two weeks, and it may take up to four weeks to experience the full benefits.
How many pills is too much? ›Taking more than five medications is called polypharmacy. The risk of harmful effects, drug interactions and hospitalizations increase when you take more medications.
What antidepressant is the most common overdose? ›Tricyclic antidepressants are among the most common type of antidepressant involved in an overdose, and the signs of an overdose can vary from one person to another.
What does antidepressant overdose look like? ›
If a person takes too many antidepressants, they can overdose. Some of the symptoms of an antidepressant overdose may include nausea, vomiting, and blurred vision. In this article, learn more about how to spot an antidepressant overdose, and what to do to keep a person who has overdosed safe.
Is trazadone hard on your liver? ›Rare instances of ALF and death from trazodone have been described. The onset of liver toxicity may occur a few days or months after drug ingestion and even after the drug has been stopped. The pattern of liver injury is usu- ally hepatocellular, but mixed or cholestatic forms have also been described.
Who should avoid trazodone? ›Trazodone may not be safe for some people to use, especially those who have heart disease, psychiatric illnesses, or are pregnant or breastfeeding. It also shouldn't be used by people under 25 or the elderly. Talk with your doctor about the possible side effects and whether it's safe for you to take trazodone.
Is trazodone linked to dementia? ›The incidence of dementia in people prescribed trazodone was higher than in matched antidepressant users (1.8 versus 1.1 per 100 person-years), with a hazard ratio (HR) of 1.80 (95% confidence interval [CI] 1.56–2.09).
Does trazodone cause memory loss? ›Additionally, an article in the Journal of Sleep Research states that prolonged use of trazodone can also cause the following: Short-term memory dysfunctions. Verbal learning issues. Equilibrium disruption.
Can trazodone cause bipolar? ›People with bipolar disorder: Trazodone can trigger a manic or hypomanic episode in people with bipolar disorder. Trazodone is not FDA-approved to treat bipolar disorder and should be avoided in this group.
Can trazodone cause seizures? ›have epilepsy or are having electroconvulsive treatment – trazodone may increase your risk of having a seizure.
Can trazodone cause nightmares? ›A withdrawal syndrome from trazodone induces a nightmare increase (78). During treatment, this molecule reduces nightmare in patients suffering from depression (79), PTSD (80), or cancer (81).
What pain reliever can I take with trazodone? ›Interactions between your drugs
No interactions were found between trazodone and Tylenol.
Trazodone Dosage for Anxiety
To treat anxiety, trazodone can be taken at a dose of 50 mg to 100 mg, two to three times daily. The total daily dosage should not exceed 400 mg.
How quickly does serotonin syndrome start? ›
Serotonin syndrome is diagnosed clinically and requires a thorough review of medications and a careful physical exam. Symptoms tend to develop rapidly after exposure to the precipitating drug: 30% within one hour, 60% within 6 hours, and nearly all patients with toxicity developing symptoms within 24 hours of exposure.
What causes brain zaps? ›Electric shock feeling in the head, also referred to as brain zaps, brain shivers, head shocks, and head zaps have three main causes: Side effects of medication. Withdrawing from medication. Chronic stress (hyperstimulation), including the stress caused by anxiety.
How do you check serotonin levels? ›The serotonin test measures the level of serotonin in the blood. Blood is drawn from a vein (venipuncture), usually from the inside of the elbow or the back of the hand. A needle is inserted into the vein, and the blood is collected in an air-tight vial or a syringe. Preparation may vary depending on the specific test.
Is trazodone hard on your heart? ›Trazodone may cause a condition that affects the heart rhythm (QT prolongation). QT prolongation can infrequently result in serious (rarely fatal) fast/irregular heartbeat and other symptoms (such as severe dizziness, fainting) that need medical attention right away.
Can trazodone cause crazy side effects? ›Check with your doctor right away if you have anxiety, restlessness, a fast heartbeat, fever, sweating, muscle spasms, twitching, nausea, vomiting, diarrhea, or see or hear things that are not there. These may be symptoms of serious conditions called serotonin syndrome and neuroleptic malignant syndrome-like reactions.
Can trazodone make your head feel weird? ›Commonly reported side effects of trazodone include: blurred vision, dizziness, drowsiness, headache, nausea, vomiting, and xerostomia. Other side effects include: syncope, edema, ataxia, confusion, diarrhea, hypotension, insomnia, sedated state, and tachycardia.
When should you not take trazodone? ›Avoid trazodone if you're recovering from a heart attack. Inform your doctor if you have abnormal heart rhythms, weakened immunity, an active infection, or liver or kidney disease. Use it cautiously if you have heart disease. Watch for adverse effects.
How is serotonin syndrome treated? ›Benzodiazepines, such as diazepam (Valium, Diastat) or lorazepam (Ativan), can help control agitation, seizures and muscle stiffness. Serotonin-production blocking agents. If other treatments aren't working, medications such as cyproheptadine can help by blocking serotonin production.
What is the rate of priapism on trazodone? ›Priapism is considered as an adverse effect occurring in less than 1% of patients on trazodone.
Is 300 mg of trazodone safe for dogs? ›There is a wide range of acceptable Trazodone dosages for dogs, although you should never exceed 300 mg per dose or 600 mg per day, regardless of how big your dog is. It is always best to do a trial run, and start with a lower dose to gauge your dog's response.
How does serotonin syndrome start? ›
Serotonin syndrome can occur via the therapeutic use of serotonergic drugs alone, an intentional overdose of serotonergic drugs, or classically, as a result of a complex drug interaction between two serotonergic drugs that work by different mechanisms. A multitude of drug combinations can result in serotonin syndrome.
What is serotonin toxicity? ›Serotonin toxicity is a drug-induced condition caused by too much serotonin in synapses in the brain. Cases requiring hospitalization are rare, and mild cases caused by serotonin-mediated side effects are unlikely to be fatal. Patients present with a combination of neuromuscular, autonomic, and mental status symptoms.
Does trazodone make it hard to climax? ›** Trazodone may cause orgasmic inhibition similar to ejaculatory inhibition in males, although this problem has never been reported in the female. Trazodone has been shown to decrease prolactin levels, to inhibit reuptake of serotonin, to produce B-receptor subsensitivity and to decrease 5-HT, binding.
What's the half-life of trazodone? ›Trazodone has biphasic elimination, with a redistribution half-life of about one hour and an elimination half-life of 10-12 hours. Trazodone is nearly completely metabolized hepatically by hydroxylation and oxidation to metabolites that are probably inactive.
Does trazodone cause arousal? ›Trazodone And Sexual Drive
Studies have evidence that it can increase sexual drive in both men and women. It is associated with prolonged erection in men and increased lubrication in women although its mechanism of increasing libido is still unknown, it is thought to be a side effect of serotonin reuptake inhibition.
Mild serotonin syndrome symptoms often includes the following: Shivering and tremors. Twitching or involuntary muscle movements. Excessive sweating.
What does mild serotonin syndrome look like? ›Mild serotonin syndrome may cause subtle symptoms, such as mild tremors, restlessness, or headaches. Signs of severe serotonin syndrome include rigid muscles, seizures, fever, and nausea or vomiting.
What should you not take with trazodone? ›Do not use trazodone with buspirone (Buspar®), fentanyl (Abstral®, Duragesic®), lithium (Eskalith®, Lithobid®), tryptophan, St. John's wort, or some pain or migraine medicines (eg, sumatriptan, tramadol, Frova®, Maxalt®, Relpax®, Zomig®).
Does trazodone cause hair loss? ›Trazodone can lead to hair loss, but it's a very rare side effect. Research has shown that trazodone may lead to hair loss only in very rare instances. In fact, this research showed there's a much higher likelihood of hair loss with other medications used to treat mental illnesses — such as lithium — over trazodone.