Always review the patient’s medication list for potential interactions. Trazodone’s sedative effects can be amplified by other central nervous system depressants, including benzodiazepines, opioids, and alcohol. This combination increases the risk of falls and sedation. Monitor patients closely for these effects, potentially adjusting dosages or considering alternative medications.
Specific Drug Interactions
Trazodone inhibits CYP2D6, an enzyme that metabolizes many drugs. This can lead to increased levels of drugs metabolized by this enzyme, such as certain antidepressants (e. g., SSRIs, SNRIs), antipsychotics (e. g., risperidone), and some beta-blockers. Close monitoring of these drugs’ effects is necessary. Conversely, drugs that induce CYP3A4 can accelerate Trazodone metabolism, potentially reducing its efficacy. Examples include rifampin and St. John’s Wort.
Precautions
Trazodone’s sedative effects pose a significant risk for falls, particularly in Alzheimer’s patients who already have gait instability. Regularly assess fall risk and implement safety measures as needed. Monitor for orthostatic hypotension, a common side effect that can increase the risk of falls. Patients should rise slowly from a sitting or lying position. Consider a lower starting dose and gradual titration to minimize side effects. Regularly monitor for signs of serotonin syndrome, especially if combined with other serotonergic medications. This involves close observation of symptoms like agitation, confusion, muscle rigidity, and fever. Finally, carefully assess the patient’s cognitive status and ability to manage medications independently. Consider the need for caregiver support in medication administration.
