Trazodone is a second-generation anti-psychotic medication prescribed to treat some of the symptoms of schizophrenia. As with all antipsychotics, this medication should be used only when absolutely necessary, as the risks of trazodone are not inconsequential. In 2011 trazodone has recently seen an upsurge in prescription for treating conditions the United States Food and Drug Administration has not yet approved it for use. The severity of trazodone side effects and its risks to patients suggest that safer alternatives treatments should first be explored, but if used the drug should be given for the shortest possible period of time and at the lowest dose sufficient for the management of symptoms. There are a number of factors that may affect the optimal initial and maintenance trazodone dose, including the patient's age, drug regimen and medical history.
When using trazadone to treat the symptoms of schizophrenia, the recommended initial adult trazodone dose is 150 to 200 mg, given orally with meals in two to three divided doses. A maintenance dose can be given, although the total daily trazadone dose should not exceed 300 to 400 mg in most circumstances. If the initial trazodone dose does not provide adequate control of symptoms, the dosage may be reviewed after a period of two weeks, with the total daily dose increased in increments of 50 mg.
Patients over the age of 65 may be more sensitive to the effects of trazodone and should initially receive half the recommended adult dose. Dosage increases should be considered only with caution. Trazodone should under no circumstances be used to treat geriatric patients with comorbid dementia, as the drug may pose a serious risk to these patients. Children should not be given trazodone, since as of 2011 the drug has not been proven safe or effective for the treatment of schizophrenia in this population.
There are a number of side effects that can affect patients taking this medication, increasing in incidence, frequency, and severity lograithmically with increases in the trazodone dose. The most common side effects of trazodone are headache, drowsiness, dry mouth, nausea and vomiting. More serious side effects include involuntary movements and muscle spasms, particularly in the head and neck as well as tremors, high blood pressure, racing heart, constipation, rash, water retention, fever, hallucinations, changes in body weight, decreased libido, painful and prolonged penile erection, impaired speech, impaired liver function, chest pain, heart attack and heart failure.