Major depressive disorder.
May be swallowed whole or broken in half along the scored line; do not crush or chew. Take on empty stomach at bedtime. ≥18yrs: Initially 150mg once daily. May increase by 75mg/day at 3-day intervals; max 375mg/day.
<18yrs: not established.
During or within 14 days of MAOIs. Concomitant linezolid or IV methylene blue.
Monitor for clinical worsening, suicidality and unusual changes in behavior, esp. during initiation and dose changes. Acute post MI: not recommended. Monitor for serotonin syndrome or neuroleptic malignant syndrome-like symptoms; discontinue if occurs. Bipolar disorder. Mania/hypomania. Psychosis. Cardiovascular disease. Predisposition to QT prolongation. Hypokalemia. Hypomagnesemia. Renal or hepatic impairment. Volume depletion. Predisposition to priapism (eg, sickle cell anemia, multiple myeloma, leukemia, or anatomically deformed penis). Write ℞ for smallest practical amount. Reevaluate periodically. Avoid abrupt cessation. Elderly. Pregnancy (Cat.C). Nursing mothers.
See Contraindications. Potentiates alcohol, barbiturates, other CNS depressants, digoxin, phenytoin, antihypertensives. Monitor for serotonin syndrome with SSRIs, SNRIs, triptans (esp. during initiation and dose increases), MAOIs, linezolid, IV methylene blue, tricyclic antidepressants, fentanyl, lithium, tramadol, tryptophan, buspirone, St. John's Wort. Potentiated by CYP3A4 inhibitors (eg, ritonavir, indinavir, ketoconazole, itraconazole). Increased risk of arrhythmias with concomitant potent CYP3A4 inhibitors or drugs that prolong the QT interval; consider lower trazodone dose. Antagonized by CYP3A4 inducers (eg, carbamazepine). Increased risk of bleeding with concomitant NSAIDs, aspirin, anticoagulants. Monitor PT with warfarin. Increased risk of hyponatremia with diuretics.
Somnolence/sedation, dizziness, constipation, blurred vision, headache, anticholinergic effects, GI upset, fatigue, myalgia, hypotension, syncope, hyponatremia, sexual dysfunction, CNS disturbances, dyspnea, night sweats, QT prolongation, torsades de pointes (possible); rare: priapism (discontinue if occurs).