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Author: Admin | 2025-04-28
Are indicative that there is a potential for interactions when trazodone is given with potent CYP3A4 inhibitors such as erythromycin, ketoconazole, itraconazole, ritonavir, indinavir, and nefazodone. It is likely that potent CYP3A4 inhibitors may lead to substantial increases in trazodone plasma concentrations. It has been confirmed in in- vivo-studies in healthy volunteers, that a ritonavir dose of 200 mg twice daily increased the plasma levels of trazodone by greater than twofold, leading to nausea, syncope and hypotension. If trazodone is used with a potent CYP3A4 inhibitor, a lower dose of trazodone should be considered. However, co-administration of trazodone and potent CYP3A4 inhibitors should be avoided where possible. Carbamazepine: Co- administration results in reduced plasma concentrations of trazodone. Concomitant use of carbamazepine 400 mg daily led to a decrease of plasma concentrations of trazodone and its active metabolite m-chlorophenylpiperazine of 76% and 60%, respectively. Patients should be closely monitored to ascertain if an increased trazodone dose is required. Tricyclic antidepressants: Concurrent administration should be avoided due to the risk of interaction. Serotonine syndrome and cardiovascular undesirable effects should be bewared. Fluoxetine: Rare cases have been reported of elevated trazodone plasma levels and adverse effects when trazodone had been combined with fluoxetine, a CYP1A2/2D6 inhibitor. The mechanism underlying a pharmacokinetic interaction is not fully understood. A pharmacodynamic interaction (serotonin syndrome) could not be excluded. Monoamine oxidase inhibitors: Possible interactions with monoamine oxidase inhibitors have occasionally been reported. Although some clinicians do give both concurrently, use of trazodone concomitantly with MAOIs, or within two weeks from discontinuation of these substances, is not recommended. The administration of MAOIs within one week since discontinuation of trazodone treatment is not recommended either. Phenothiazines: Severe orthostatic hypotension has been observed in case of concomitant use of phenothiazines, like e.g. chlorpromazine, fluphenazine, levomepromazine, perphenazine. Anaesthetics/muscle relaxants: Trazodone may enhance the effects of muscle relaxants and volatile anaesthetics, and caution should be exercised in such instances. Alcohol: Trazodone intensifies the sedative effects of alcohol. Alcohol should be avoided during trazodone therapy. Levodopa: Antidepressants can accelerate the metabolism of levodopa. Other: Concomitant use of trazodone with medicinal products known to
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