Trazodone Overdose: Symptoms, Risks, and Treatment Options

A trazodone overdose can be a serious medical emergency. While trazodone is typically prescribed to treat major depressive disorder, some individuals are prescribed trazodone at lower doses to treat their insomnia or anxiety symptoms. Because trazodone can cause sedation, some people assume it is safer than other prescription medications. That assumption can be dangerous.

Because trazodone can impact the brain, heart rate, blood pressure, respiration, and nervous system, it can cause a variety of systemic effects. When trazodone is taken with alcohol, benzodiazepines, opioids, or other sedating medications, the risk of overdose can increase.

What Is Trazodone?

Trazodone is classified as a serotonin reuptake inhibitor and 5-HT2 receptor antagonist. [1] It is typically classified clinically as a serotonin antagonist and reuptake inhibitor, or SARI. Trazodone affects serotonin and other receptor systems, which helps explain side effects such as sedation, dizziness, dry mouth, low blood pressure, and sleepiness. These include sedation, dizziness, dry mouth, decreased blood pressure, and somnolence (sleepiness).

Other brand names have included Desyrel and Oleptro; however, many people take generic versions of trazodone.

How Much Trazodone Is Safe to Take?

Only your doctor will know what dosage of trazodone is best for you. For the treatment of major depressive disorder in adults, the United States Food and Drug Administration (FDA)-approved labeling indicates that the recommended starting dose is 150 mg/day in divided doses. Maximum daily doses for outpatients should not exceed 400 mg per day in divided doses, while hospitalized patients may receive up to 600 mg per day in divided doses when necessary.

This does not mean 400 mg or 600 mg is safe for everyone. A lower dose may be too much for some people. Many factors influence what constitutes the maximum safe dosage for each person, including pre-existing heart problems, impaired kidneys or liver, low blood pressure, concurrent use of other sedating medications, and alcohol consumption.

How Much Trazodone Is Too Much to Take?

No matter what the maximum recommended dose is for your condition, any amount above your prescribed dose can increase the risk of side effects, toxicity, or overdose. Examples of situations that may lead to an elevated risk of an adverse reaction include:

• Consuming excessive amounts of trazodone
• Consuming too many trazodone tablets within a short time frame
• Using someone else’s trazodone prescription
• Mixing trazodone with alcohol
• Mixing trazodone with benzodiazepines
• Mixing trazodone with opioids
• Combining trazodone with another antidepressant
• Taking trazodone along with medications that affect cardiac rhythms
• Taking trazodone along with potent CYP3A4 inhibitors
• Having pre-existing heart conditions or a history of QT prolongation
• Not having taken trazodone for an extended period

You cannot determine whether the amount you have taken is enough to cause harm at home. If there is any possibility that you may have overdosed on trazodone, please call either Poison Control or emergency services.

Symptoms of Trazodone Overdose

Depending on the severity of the overdose and what substances may have been taken simultaneously with it (e.g., alcohol), the signs and symptoms can vary widely in severity from mild to life-threatening. MedlinePlus provides comprehensive listings of overdose symptoms related to trazodone. These symptoms may involve breathing difficulties, heart and vascular issues, and neurological dysfunction. [2] Possible symptoms may include:

• Extreme drowsiness
• Confusion
• Vomiting
• Dizziness or fainting
• Low blood pressure
• Irregular heartbeat
• Slow heart rate
• Trouble breathing
• Stopped breathing
• Poor coordination
• Shakiness (tremor)
• Seizures
• Coma
• Priapism (prolonged erection)
• Symptoms of serotonin syndrome

Priapism is a prolonged erection that requires urgent medical care because it can cause permanent injury.

In addition to these symptoms of trazodone toxicity, it is possible to experience symptoms related to serotonin syndrome. Serotonin syndrome can manifest itself physically and mentally. Physical symptoms may include rapid heartbeat, unstable blood pressure, sweating, fever, nausea, vomiting, diarrhea, shivering, muscle stiffness, convulsions (seizures), and confusion. People suffering from serotonin syndrome may also experience hallucinations and agitation. The risk for developing serotonin syndrome can increase when trazodone is used with selective serotonin reuptake inhibitors (SSRIs), serotonin norepinephrine reuptake inhibitors (SNRIs), fentanyl, tramadol, lithium, buspirone, St. John’s Wort, or monoamine oxidase inhibitors (MAOIs).

Trazodone Toxicity and Heart Risks

Overdoses of trazodone can negatively affect cardiovascular performance. One particular concern is QT prolongation, a change in the electrical cycle of the heart that can increase the likelihood of potentially lethal arrhythmias. In addition to increasing the potential for arrhythmias, trazodone can also contribute to low blood pressure, fainting spells, slow heart rate, and/or irregular heartbeats.

The product labeling for trazodone states that trazodone prolongs the QT interval and cautions against using it in patients with known QT prolongation or when combining it with drugs known to prolong QT intervals. [3] The labeling further notes that among the most severe reactions reported due solely to trazodone overdose were priapism, respiratory arrest, seizures, and changes in the electrocardiogram indicative of QT prolongation. These risks are why clinical evaluation for trazodone overdose may include measuring vital signs, electrocardiogram (ECG) monitoring, and laboratory studies.

Can Trazodone Overdose Cause Death?

Yes. Death resulting from trazodone overdose is possible, particularly when mixing it with other CNS depressants.

According to the labeling for trazodone products, deaths have resulted from overdoses involving combinations of trazodone and CNS depressant medications such as alcohol and some sedatives. Additionally, the labeling points out that there is no established antidote for overdoses involving trazodone.

If you find someone who appears severely intoxicated or sleeping excessively and has difficulty waking, is breathing extremely slowly, has bluish-gray colored skin around the nose, mouth, lips, or face, or loses responsiveness or alertness, call 911 immediately.

How Long Does Trazodone Overdose Last?

There is no single timeline for how long a trazodone overdose lasts. Symptoms can vary based on the amount taken, other substances involved, age, liver function, kidney function, heart health, and how quickly treatment begins.

As a general rule, medical personnel will continue to monitor vital signs until all systems appear stable. If other substances were likely taken prior to admission, duration of treatment may extend far beyond what would normally occur if only trazodone had been involved.

Do not wait for symptoms to subside after a suspected overdose has occurred. Seek medical attention immediately!

Trazodone Overdose Treatment

Trazodone overdose treatment should be handled by medical professionals, whether the overdose was accidental or intentional. The nature and extent of treatment depend on individualized circumstances surrounding the overdose.

Potential treatment options may include:

• Calling Poison Control for guidance in toxicology
• Monitoring vital signs
• ECG monitoring
• Blood workup
• IV fluids for hypotension
• Breathing support if needed
• Medication to suppress seizures
• Monitoring for serotonin syndrome
• Monitoring for priapism
• Observation until all vital signs are stable

MedlinePlus advises immediate medical attention after an overdose occurs and does not recommend inducing vomiting except under direction from Poison Control or a medical provider.

If an overdose of trazodone was potentially intentional, the individual will require a mental health evaluation and a safety plan once their acute medical condition has stabilized.

Trazodone, Substance Use, and Mental Health

Trazodone is not a controlled substance, and it is not usually considered addictive in the same way as opioids, benzodiazepines, or stimulants. Still, misuse of trazodone is possible. Misuse of trazodone can occur through taking excessive amounts to fall asleep, to manage emotional pain (self-medicate), to treat anxiety, and/or to mix with other substances. Warning signs may include:

• Taking high doses of trazodone
• Running out of medicine early
• Combining trazodone with alcohol or sedatives
• Using trazodone while using opioids or benzodiazepines
• Using someone else’s prescription
• Needing increasingly large amounts of trazodone to fall asleep
• Taking trazodone in combination with other prescription medications
• Using trazodone after a relapse
• Thinking about self-harm

Stopping trazodone abruptly is dangerous without first consulting a physician. The label states that withdrawal symptoms may include anxiety, agitation, and sleeping difficulties. It suggests gradually reducing the dosage prior to stopping.

Prescription Drug Treatment in Scottsville, Kentucky

Aura Recovery Center provides addiction treatment in Scottsville, Kentucky, for individuals struggling with substance use and co-occurring mental health conditions.

For someone having difficulty managing trazodone use, care may begin with an evaluation of their medication use, overall health, withdrawal concerns, and any co-occurring mental health needs. For individuals experiencing problematic medication use alongside depression, anxiety, or another mental health condition, dual diagnosis treatment can address substance use and co-occurring disorders together.

If trazodone use, difficulty controlling medication use, depression, anxiety, or other co-occurring concerns have become difficult to manage, a professional assessment can help determine the appropriate level of treatment and support.

Frequently Asked Questions About Trazodone Overdose