Desyrel
Desyrel (generic name: Trazodone) is an oral antidepressant drug that affects the chemical messengers (neurotransmitters) within the brain that nerves use to communicate with (stimulate) each other. The major neurotransmitters are acetylcholine, norepinephrine, dopamine and serotonin. Many experts believe that an imbalance among the different neurotransmitters is the cause of depression. Although the exact mechanism of action of trazodone is unknown, it probably improves symptoms of depression by inhibiting the uptake of serotonin by nerves in the brain. This results in more serotonin to stimulate other nerves. Desyrel also may increase directly the action of serotonin. Trazodone is chemically unrelated to the selective serotonin reuptake inhibitors (SSRIs), the tricyclic antidepressants (TCAs) or the monoamine oxidase inhibitors (MAO inhibitors). It is chemically related to nefazodone (Serzone) and shares its actions. Desyrel was approved by the FDA in 1982.
All antidepressants that increase concentrations of serotonin in the brain, including trazodone, should not be taken with MAO-inhibitors. Drugs in the MAO-inhibitor class include isocarboxazid (Marplan), phenelzine (Nardil), tranylcypromine (Parnate), and procarbazine (Matulane). Such combinations may lead to confusion, high blood pressure and tremor. This same type of interaction may occur when trazodone is used with selegiline (Eldepryl). If a patient is switched from trazodone to an MAO inhibitor, at least one week should be allowed after stopping trazodone before the MAO inhibitor is begun. After stopping an MAO inhibitor, two weeks should elapse before starting trazodone.
Increased blood concentrations of digoxin and phenytoin (Dilantin) have been reported in persons taking trazodone due to a decrease in the metabolism (break-down and elimination) of these drugs by trazodone.
Carbamazepine (Tegretol) may decrease blood levels of trazodone by increasing its elimination from the body. Ketoconazole (Nizoral), ritonavir (Norvir), and indinavir (Crixivan) inhibit the breakdown of trazodone leading to increased blood levels of trazodone and potential side effects.
Desyrel side effects
The most common side effects associated with trazodone are nausea, dizziness, insomnia, agitation, tiredness, dry mouth, constipation, lightheadedness, headache, low blood pressure, blurred vision, and confusion. Priapism (including clitoral priapism in women), a painful condition in which the penis (or clitoris) remains in an erect position for a prolonged period, has been reported in patients receiving trazodone. Priapism occasionally results in permanent impairment of erectile function or impotence. Patients should be warned of the possibility of priapism and told to discontinue the drug at once and consult with their physician if this reaction occurs. Trazodone also may affect ejaculation, orgasm and libido.
Antidepressants increased the risk of suicidal thinking and behavior (suicidality) in short-term studies in children and adolescents with depression and other psychiatric disorders. Anyone considering the use of Desyrel or any other antidepressant in a child or adolescent must balance this risk with the clinical need. Patients who are started on therapy should be closely observed for clinical worsening, suicidality, or unusual changes in behavior.