Before diving into “Is Trazodone a narcotic drug”, let’s first understand what narcotics are. Drugs that relieve pain; while creating a state of unconsciousness, and addiction/dependence on the drug. Narcotics act like opioids but are not made from opium.

Is Trazodone a Narcotic drug?

No, Trazodone is not a narcotic medication. Trazodone, on the other hand, is classified as an antidepressant and sedative medication that works by inhibiting the reuptake of serotonin by your brain, thus more serotonin is produced naturally.

Half-life of Trazodone:

The time taken by your body to reduce the drug by half is its half-life. The half-life of trazodone is 7-9 hours (approx.). However, depending on factors like an individual’s metabolism, it can take longer for the drug to be eliminated from your body.

How Does Trazodone Work?

Trazodone primarily works by inhibiting the reuptake of serotonin in the brain. This increases the availability of serotonin, which is thought to improve mood and reduce anxiety. Additionally, trazodone has antagonistic effects on certain serotonin receptors, which contributes to its sedative properties.

Metabolism:

Any drug you consume is metabolized or say digested by your body. Different enzymes are responsible for metabolizing different compounds in a drug. How quickly or slowly a drug is processed in your body can thus vary based on genetic factors, and a few other factors, including any medications a person might be consuming.

For these reasons, some individuals may metabolize a certain drug rapidly, while others don’t, and vice versa. Trazodone is metabolized in the liver by the enzyme CYP3A4.
Factors that can influence drug metabolism:

• Age: Older adults may experience more noticeable sedative effects and may have a slower metabolism of trazodone, requiring adjustments to dosage.
• Sex: Men and women may metabolize trazodone at different rates, with women sometimes experiencing higher blood levels of the drug.
• Metabolism: Differences in DNA segments or genes can affect the metabolism of CYP3A4. This results in faster or slower absorption of a compound by your body and could affect the drug’s efficacy and side effects.
• Other factors: Liver function, kidney health, and overall health status play a significant role in how trazodone is processed and how it works.

How Quickly Does Trazodone Start Working? Indications and FDA-warnings

Trazodone usually starts to show effects within 30 minutes to 1 hour after taking it, especially for its sedative effects. However, it may take several weeks for the full antidepressant effects to become noticeable, as is common with many antidepressants.

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FDA Warnings

The FDA has issued several warnings for trazodone, and patients should be aware of the following:

• Suicidal Thoughts: Like other antidepressants, trazodone carries a Black Box Warning regarding an increased risk of suicidal thoughts and behaviors, particularly in children, adolescents, and young adults.
• Serotonin Syndrome: Trazodone can increase serotonin levels, which can lead to a potentially life-threatening condition known as serotonin syndrome if combined with other drugs that increase serotonin (e.g., other antidepressants, certain pain medications).
• QT Prolongation: Trazodone can prolong the QT interval on the heart’s electrocardiogram (ECG), which could lead to serious heart arrhythmias. Patients with a history of heart problems should be monitored.
• Sedation: Due to its sedative properties, trazodone may cause drowsiness, so it is important to avoid activities that require alertness (such as driving) until you know how it affects you.

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Indications

Trazodone is prescribed for several conditions, including:

• Depression: As an antidepressant, trazodone is used to treat major depressive disorder.
• Anxiety: It may be prescribed off-label to help manage anxiety disorders.
• Insomnia: Due to its sedative effects, trazodone is frequently used off-label for managing insomnia or sleep disturbances.
• Chronic Pain: Sometimes, trazodone is used to manage pain, particularly in cases where sleep disruption is a concern.

When Should Trazodone Be Taken?

Trazodone is typically taken at night due to its sedative effects. The exact timing and dosage should be guided by a healthcare provider based on the individual’s needs.

Drug Interactions:

Trazodone can interact with several medications, including:

• Other antidepressants, particularly SSRIs, SNRIs, or other MAO inhibitors, as these can increase the risk of serotonin syndrome.
• Alcohol and benzodiazepines can increase the sedative effects of trazodone, leading to excessive drowsiness and other serious side effects.
• CYP3A4 inhibitors (e.g., certain antifungal medications, antibiotics) can increase trazodone levels in the blood, raising the risk of side effects.

How to Know if the Drug Is Working:

If trazodone is working, you may notice improvements in mood, sleep quality, and a reduction in anxiety. However, for full effects, it may take 1-2 weeks to feel the antidepressant benefits. If you’re taking trazodone for sleep, you might feel more rested and find it easier to fall and stay asleep.

Negative Signs Needing Urgent Medical Assistance:

• Severe drowsiness or dizziness: Could indicate a dangerous drop in blood pressure.
• Symptoms of serotonin syndrome: Include rapid heart rate, high fever, muscle stiffness, confusion, and seizures.
• Signs of an allergic reaction: Rash, itching, swelling, and trouble breathing.

Is Trazodone Addictive?

Trazodone is generally not considered addictive. It does not produce the euphoria associated with substances that are typically addictive, such as narcotics or benzodiazepines. However, misusing the medicine or stopping trazodone suddenly can lead to withdrawal symptoms, so it is recommended to taper off the medication under the guidance of a healthcare provider if it needs to be discontinued.

Can PGx Testing Determine If Trazodone Is Suitable for You?

Pharmacogenetic (PGx) testing may be useful in determining how your body will metabolize trazodone. PGx tests examine genetic variations in enzymes like CYP3A4 (which metabolizes trazodone) and CYP2D6 to help predict how efficiently you will process the drug. This information can help doctors select and adjust the right drug and dosage for better efficacy and reduced risk of side effects.

Conclusion:

Trazodone is not a narcotic drug. It belongs to SARIs and is primarily prescribed for its sedative and antidepressant effects. Belonging to the cytochrome family P450, CYP3A4 enzyme is responsible for metabolizing this drug in the liver. Since mental health medications can affect people differently, getting a pharmacogenomics test at home can help you and your doctor select the right drugs and the right dosage.

References:

https://pubmed.ncbi.nlm.nih.gov/7032872/
https://www.accessdata.fda.gov/drugsatfda_docs/label/2015/071196s062lbl.pdf
https://pubmed.ncbi.nlm.nih.gov/22712761/

Disclaimer: This blog is only for informational purposes. Always consult a healthcare specialist before taking any medical action.