Trazodone Vs Doxepin
Drug Class
Tricyclic antidepressant (TCA)
Serotonin antagonist and reuptake inhibitor (SARI)
Primary Uses
Depression, anxiety, insomnia, and chronic idiopathic urticaria
Depression, insomnia, anxiety disorders, and sometimes off-label for chronic pain
Mechanism of Action
Inhibits reuptake of norepinephrine and serotonin; antagonizes histamine H1 receptors
Inhibits serotonin reuptake and blocks serotonin 2A receptors
Dosage Forms
Capsules, tablets, topical cream, oral solution
Tablets, extended-release tablets
Typical Dosage
Depression: 25–150 mg/day (divided doses) - Insomnia: 3–6 mg once nightly
Depression: 150–400 mg/day (divided doses)- Insomnia: 25–100 mg once nightly
Onset of Action
1–2 weeks for depression; within hours for insomnia
1–2 weeks for depression; within hours for insomnia
Half-Life
15–18 hours
3–9 hours
Metabolism
Liver (CYP2D6)
Liver (CYP3A4 and CYP2D6)
Common Side Effects
Drowsiness, dry mouth, dizziness, weight gain, blurred vision, constipation
Drowsiness, dizziness, dry mouth, headache, nausea, priapism (rare but serious)
Serious Side Effects
Cardiac arrhythmias, orthostatic hypotension, suicidal thoughts in young adults
Suicidal thoughts in young adults, priapism, serotonin syndrome
Contraindications
MAOI use within 14 days, untreated glaucoma, severe urinary retention
MAOI use within 14 days, hypersensitivity to trazodone
Pregnancy Category
C (Risk not ruled out; use only if benefits outweigh risks)
C (Risk not ruled out; use only if benefits outweigh risks)
Lactation
May pass into breast milk; use with caution
Limited data; use with caution
Drug Interactions
CNS depressants, MAOIs, anticholinergic drugs - CYP2D6 inhibitors can increase plasma levels
- CNS depressants, serotonergic drugs (risk of serotonin syndrome)- CYP3A4 inhibitors can increase plasma levels
Special Populations
Adjust dosage for elderly or those with hepatic impairment
- Adjust dosage for elderly or those with hepatic impairment
Cost (Generic)
Low (widely available as generic)
Low (widely available as generic)
Monitoring Requirements
ECG in elderly or those with cardiac conditions, liver function tests
Monitor for mood changes, signs of serotonin syndrome, and liver function
Advantages
Effective for insomnia at lower doses
Dual use for depression and insomnia; less sedating at higher doses
Disadvantages
More anticholinergic effects (e.g., dry mouth, blurred vision)
Risk of priapism, requires careful monitoring of mood changes
Coupon
