Trazodone Overdose Dangers

What is Trazodone?

Trazodone is an antidepressant medication that has several off-label uses, including the treatment of insomnia, anxiety, bulimia, Alzheimer’s disease, and even substance abuse treatment.1 The drug was formerly available as Oleptro and Desyrel, but both brands are now discontinued.2

  • Trazodone acts to inhibit the reuptake of the neurotransmitter serotonin, effectively increasing the availability of serotonin in the brain.1 Serotonin is involved in processes that regulate mood,Signs of Trazodone Overdoseemotions, sleep, memory, appetite, and more.3 Research evidence supports an association between deficits in serotonergic neurotransmission and depression and suicide risk.4

Trazodone Overdose

  • While trazodone is relatively safe and is not typically thought of as a drug of abuse, some people may take toxic amounts of trazodone either accidentally or purposefully.
  • Trazodone overdose can result in serious and sometimes life-threatening symptoms. Trazodone toxicity can disrupt several physiological processes, which can have a negative impact on vital functions such as heart rate, blood pressure, and respiration.5
  • Though somewhat rare, there have been some cases of trazodone related fatalities. Intentional misuse of trazodone and resulting toxicity increases this risk, as well as those of a range of short-term and long-term effects.6

Trazodone Side Effects

When used as directed under medical supervision and direction, trazodone can be a relatively safe therapeutic medication; however, there are several troublesome side effects that could be made more severe in overdose, including the following:6

  • Confusion
  • Disorientation.
  • Incoordination.
  • Lightheadedness.
  • Dizziness and/or unsteadiness.
  • Fainting.
  • Sweating.
  • Racing heartbeat.
  • Chest pain.
  • Diarrhea.
  • Muscle pain.
  • Changes to sexual desire and/or impaired sexual functioning.

The drug should only be taken as prescribed by a medical professional. This is especially important for the younger population of trazodone users. The U.S. National Library of Medicine (NLM) warns that taking trazodone may actually increase suicidal thoughts and tendencies in some people, especially in children, adolescents, and young adults under the age of 25, and it can have unpredictable effects on a person’s mental health status. An increase in suicidal ideation could also occur any time the dose is increased, so those who are misusing the drug may be in greater danger.6 Always report any suicidal thoughts to your physician, and seek emergency help if you have immediate thoughts of attempting suicide.

Trazodone Overdose Risk

Trazodone is relatively safe in overdose; when medical help is received, death or permanent harm is unlikely.5,10 Mixing trazodone with alcohol, benzodiazepines, or other central nervous system depressants, however, can increase the likelihood of overdose complications and/or death.5,7,8,9

Signs of Trazodone Overdose

Characteristics of a Trazodone Overdose

The following are potential signs of a trazodone overdose:9

  • Severe drowsiness
  • Vomiting
  • Priapism (erection that is prolonged and usually without sexual arousal)
  • Heart rhythm irregularities
  • Seizures
  • Respiratory arrest

Trazodone can also cause hyponatremia (low sodium in the blood that can lead to difficulty walking/feeling unsteady, headache, confusion, troubles concentrating, weakness, and memory issues), as well as a very dangerous condition called serotonin syndrome, which is characterized by significantly severe symptoms such as hallucinations, agitation, rapid heartbeat, changes in mental status, coordination problems, dizziness, gastrointestinal distress, rapid heart rate, delirium, and seizures.9,11

A trazodone overdose can be complicated by the presence of other drugs or alcohol as well as by medical or mental health conditions. Biological and genetic factors, such as metabolism, family or personal history of mental illness and/or substance abuse and addiction, can also play a role in the severity of a trazodone overdose.

There is no specific medication to reverse a trazodone overdose; however, medical intervention could be necessary to manage and minimize the possible effects of an overdose.9,10A trazodone overdose can be complicated by the presence of other drugs or alcohol as well as by medical or mental health conditions.

How Much Trazodone to Overdose?

Though trazodone is a relatively safe medication and often not a drug thought of when it comes to abuse, overdosing on trazodone is possible. But the dosage of trazodone varies based on the condition it is prescribed to treat, and therefore the amount needed to overdose changes, too. 

Factors that contribute to this include kidney functionality as this is the organ processing the medication and removing the drug from the body. Overdose isn’t reliant on the body processing the medication though. A trazodone overdose is dependent on other substances in your body such as alcohol and benzodiazepines.

For adult patients, a typical recommended trazodone dosage is around 150 mg per day, although the maximum dose can surpass 400 mg. Depending on the condition the medication is prescribed for, like major depressive disorder and severe depression, inpatient treatment dosages may surpass 600 mg per day.

Anything beyond the above dosages can be a risk of an overdose of trazodone. 

Trazodone Abuse Treatment

Any time a person uses a drug without medical direction or need, it is abuse. The National Institute on Drug Abuse estimates that over 50 million adults in the United States have abused a prescription medication for non-medical purposes at some point in their lives. Prescription drug abuse is a public health concern that impacts nearly one-quarter of the American adult population.

Trazodone, and other prescription drug abuse, is risky, and the odds of an overdose are greatly raised by medication misuse, especially when multiple substances are involved. Addiction treatment, or rehab, can reduce the risk of overdose by managing medication misuse and physical dependence. Treatment, whether inpatient or outpatient, can help a person uncover the  potential triggers, or stressors, that may be encouraging their drug abuse and manage any potential co-occurring medical and/or mental health disorders. At the same time, rehab can address the physical and emotional impact of medication misuse.

References:

  1. Shin JJ, Saadabadi A. Trazodone. [Updated 2019 Jan 13]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-.
  2. U.S. Food & Drug Administration. (2019). FDA Approved Drug Products: Search Results for “trazodone.” 
  3. National Institute on Drug Abuse. (2007). The Neurobiology of Ecstasy (MDMA).
  4. Harvard Health Publishing. (2017). What causes depression?
  5. National Library of Medicine, Toxicology Data Network. (2016). Trazodone.
  6. U.S. National Library of Medicine. (2017). Trazodone.
  7. University of Michigan. (n.d.). Trazodone.
  8. Genetic Science Learning Center. (n.d.). Drug Delivery Methods.
  9. Desyrel, Highlights of Prescribing Information.
  10. U.S. National Library of Medicine. (2017). Trazodone hydrochloride overdose. 
  11. Volpi-Abadie, J., Kaye, A. M., & Kaye, A. D. (2013). Serotonin syndromeThe Ochsner journal13(4), 533–540.
  12. National Institute on Drug Abuse. (2011). Prescription Drug Abuse.
About The Contributor
Scot Thomas, M.D.
Senior Medical Editor, American Addiction Centers
Dr. Thomas received his medical degree from the University of California, San Diego School of Medicine. During his medical studies, Dr. Thomas saw firsthand the multitude of lives impacted by struggles with substance abuse and addiction, motivating... Read More
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