Trazodone, known in Egypt as Trittico, is a relatively old antidepressant that has gained unexpected fame: it is now prescribed frequently for people who can’t sleep, even if they aren’t depressed. This fame needs clarification, as the sleep the medicine gives isn’t free, and it has warnings including low blood pressure on standing, and a rare, painful condition called priapism (a prolonged erection) that calls for going to the emergency department immediately. In this article you will learn who it is prescribed for, how it works, what worries doctors about it, and whether it is a safe sleeping pill. No doses here; starting, adjusting and stopping are with the doctor only.
What is trazodone?
It is an antidepressant from a class called serotonin antagonists and reuptake inhibitors. This means it partly raises serotonin, but also blocks other receptors in the brain, most prominently histamine and alpha-1 receptors, and this is where its sedating effect comes from. That is why its behavior differs from sertraline, for example, as in our article on sertraline, as drowsiness dominates more than activation.
Trittico and its names in pharmacies
The original name in circulation in Egypt is Trittico, and it is made in different strengths, and there are equivalent names carrying the same substance. A different name doesn’t change the active substance, so don’t combine two of them, and don’t swap the medicine for another pack without asking the pharmacist. And always make sure what you buy is on prescription and in an intact pack from a licensed pharmacy.
What is trazodone used for?
- Depression: this is the approved use, especially when accompanied by anxiety and insomnia.
- Insomnia linked to depression or anxiety: sleep comes faster and deeper for some patients.
- Insomnia alone: a common off-label use, about which medical bodies’ opinions differ because the evidence is limited.
- A supportive addition: it is sometimes added to an activating antidepressant to ease the insomnia it causes.
Trazodone and sleep: is it a good sleeping pill?
What tempts people is that it doesn’t resemble the well-known sleeping pills, so the body doesn’t depend on it in the same way. But “doesn’t cause addiction” doesn’t mean “safe for everyone” or “a treatment for insomnia”. Insomnia has many causes: anxiety, depression, sleep apnea, caffeine, staying up late, drugs. Treating the cause and adjusting sleep habits is the first step, as we explain in our insomnia guide. You will find traditional sleeping pills and their dangers in sleeping pill addiction.
Common side effects
- Drowsiness and heaviness in the morning, especially in the first days.
- Dizziness and a drop on standing up quickly because of low blood pressure.
- Dry mouth and a strange taste in the mouth.
- Headache and nausea.
- Blurred vision and a blocked nose.
- A slight increase in weight in some patients.
Dizziness at night is a particular danger for older people because it may lead to a fall and a fracture. Get up slowly from bed, and tell your doctor if it recurs.
Priapism: a rare warning that isn’t ignored
This is the best-known warning in the medicine’s leaflet, and it is rare but an emergency. It concerns a painful erection that lasts for hours without sexual desire, medically called priapism. If left untreated it may leave permanent damage to the tissue. The patient is sometimes embarrassed and delays, and the delay is the real danger.
If the erection lasts more than about four hours, or is painful, go to the emergency department and don’t wait for it to pass. The condition also occurs in women in another very rare form involving painful swelling of the clitoris. The risk is thought to be higher with some diseases such as sickle cell anemia. For the general relationship between psychiatric medicines and sexual life you can refer to antidepressants.
Call an ambulance on 123 immediately if you see
After taking trazodone, or after an excess amount of it or mixing it with sedatives or alcohol:
- A painful erection lasting more than four hours
- Deep drowsiness or difficulty waking
- Fainting or a severe drop in blood pressure
- A fast or irregular heartbeat, or palpitations with dizziness
- A high temperature with tremor or muscle stiffness
- Seizures or slow breathing
Its effect on the heart and sodium
Trazodone may prolong the QT interval on an ECG in some people, an electrical disturbance that may lead to dangerous irregularity. That is why the doctor asks about heart disease and sudden fainting in the family, and may request an ECG, especially in older people or those taking other medicines that affect the heart. Like other antidepressants, blood sodium may fall in older people, causing confusion, headache and weakness. These are among the reasons follow-up isn’t a luxury.
Interactions and dangerous mixing
Trazodone is a sedative, so alcohol doubles its drowsiness and dizziness, and combining it with benzodiazepines, pregabalin, tramadol or opioids increases the depression of breathing and consciousness. Combining it with medicines that raise serotonin, such as other antidepressants, tramadol or some migraine medicines, may cause serotonin syndrome, an emergency. And with medicines that inhibit the same liver enzyme, such as some antifungals and antibiotics, the medicine’s blood level rises. Tell your doctor about everything you take, even herbs. And if your insomnia is linked to substance use, it needs a plan, not just a pill, as in our dual diagnosis program.
The first days: how do you deal with them?
Most problems appear in the first week, which is why some simple habits help. Avoid driving and operating machines until you know how the medicine affects you. Don’t drink alcohol, even a little. Get up from the bed and the chair slowly. Keep the room dark and quiet, and stop coffee after the afternoon, as the medicine doesn’t make up for chaotic sleep. And if you feel a morning heaviness that disrupts your work, tell the doctor so he can review the timing of the medicine instead of changing it yourself.
And don’t give your tablets to a friend who can’t sleep, as what suits you may not suit him because of his heart, blood pressure or another medicine he takes. For a comparison between it and another medicine that causes drowsiness, read mirtazapine; the first tends towards rest and sleep without noticeable increase in appetite, the second increases hunger, and the choice between them is the doctor’s alone.
Pregnancy, breastfeeding and older people
There is no general decision; the doctor weighs the risk of untreated depression and insomnia to the mother against the information available about the medicine. And if pregnancy occurs during treatment, don’t stop it suddenly. Older people are more prone to dizziness, falls and low sodium, so they need caution and follow-up.
When does it start working and how is it stopped?
Its effect on sleep usually appears early, within days. Improvement in mood usually needs weeks. Don’t decide to stop when sleep improves, nor to increase when the effect is delayed. Stopping suddenly after long use may cause rebound insomnia, anxiety, irritability and flu-like symptoms, which is why the doctor sets a gradual reduction plan. More in antidepressant withdrawal symptoms.
Does trazodone cause addiction?
It isn’t considered addictive in the known sense; it gives no high and doesn’t push towards escalating increases. But a person may become psychologically attached to the medicine as a condition for sleep, and fear a night without it, and this needs behavioral treatment. In someone with a previous addiction, the doctor chooses cautiously and monitors use. Details in Are psychiatric medicines addictive?
If you have been taking trazodone for sleep for months and don’t know how to leave it, or your insomnia is mixed with substance use, book your free first consultation at Riviera Life, Sheikh Zayed, Giza, with a consultant psychiatrist, in complete confidentiality, and we will set you a clear plan.
More from our psychiatric medicines guide
- Psychiatric medicines: the complete guide
- Mirtazapine: drowsiness, appetite and warnings
- Sleep disorders: types, causes and treatment
- Antidepressants: their types and how they work
Questions many people ask
Trittico is a trade name containing the substance trazodone. Don't combine two packs of the same substance and don't swap them without the pharmacist.
It is an antidepressant that causes drowsiness, and is used for sleep off-label, and the evidence for its benefit in insomnia alone is limited.
If a painful erection lasts more than about four hours without sexual desire, go to the emergency department immediately.
It gives no high and its amount doesn't escalate like traditional sleeping pills, but psychological attachment to it for sleep is possible.
The medicine lowers blood pressure on standing, so get up slowly and tell your doctor if the dizziness or fainting recurs.
