Are There Dangers of Mixing Trazodone With Alcohol?

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Specifics of Trazodone

Trazodone is a serotonin receptor antagonist and reuptake inhibitor (SARI). The drug is believed to increase serotonergic activity in the central nervous system. It does this by inhibiting neuronal reuptake of serotonin and acting as an antagonist on the 5HT_2A subset of serotonin receptors.¹ By increasing serotonin activity throughout the brain, certain types of antidepressants are believed to reduce the symptoms of major depressive disorder. However, the theory that low serotonin levels cause depression has been called into question in recent years.²

Trazodone is also used off-label to treat a broad range of conditions, such as insomnia, anxiety, Alzheimer’s disease, substance abuse, schizophrenia, bulimia, and fibromyalgia.³

Side effects of trazodone can include:⁴

• Somnolence/sedation.
• Dry mouth.
• Dizziness.
• Confusion.
• Uncoordinated movements.
• Headache.
• Nausea.
• Constipation.
• Fatigue.
• Blurred vision.

Rare and more serious side effects may include:⁴

• Suicide risk.
• Serotonin syndrome (a serious reaction that can include hallucinations, irregular heartbeat, and coma).
• Increased bleeding risk, especially when taken with NSAIDs (ibuprofen) or other anticoagulants.
• Irregular heart rhythms (QT interval prolongation) and risk of sudden death.
• Low sodium levels in the blood (hyponatremia).
• Painful, long-lasting erection (priapism).
• Cognitive impairment.
• Motor impairment.

Anyone experiencing serious side effects should contact their physician.

Alcohol Specifics

Alcohol is a central nervous system depressant. It acts on a large number of neural targets and several neurotransmitter systems. However, it is thought to primarily achieve its intoxicating effects by decreasing the effect of excitatory neurotransmitters in the brain and increasing the effect of inhibitory neurotransmitters. Excitatory neurotransmitters stimulate or excite the brain, and inhibitory neurotransmitters have a calming or sedative effect.⁵

Effects of alcohol on the brain and body include:⁶

• Diminished reaction time.
• Blurred vision.
• Poor coordination.
• Decreased alertness.
• Impaired judgment.

Alcohol is one of the most widely abused drugs in the United States. According to the Substance Abuse and Mental Health Services Administration, an estimated 14.5 million people age 12 and older had an alcohol use disorder, or alcoholism, in 2017.⁷

The Potential for Trazodone Abuse

When taken as prescribed, antidepressant medications like trazodone are not associated with a rewarding, euphoric high like many other prescription drugs of abuse such as prescription opioid drugs, benzodiazepines, or stimulants.

Therefore, for the most part, antidepressant medications like trazodone are not significant drugs of abuse. In fact, clinical studies of trazodone found no evidence of drug-seeking behavior in participants.¹ A 2014 literature review of antidepressant abuse found no published cases to provide evidence of any extensive abuse of trazodone.⁸

That said, one case study in 1994 documented Prozac and trazodone abuse in an individual who consumed Prozac as a “substitute” for “speed” and trazodone for an alcohol-like sedative effect.⁹

But most people who take antidepressants such as trazodone do not abuse them. Trazodone overdoses are not very common, but they can occur. In other documented cases of antidepressant abuse, the person abusing the medication often has a history of substance abuse or mood disorders.⁸

Effects & Overdose Potential of Mixing

Drinking alcohol while taking trazodone can be dangerous.

Trazodone may amplify some of the effects of alcohol, which can lead to dangerous levels of intoxication and even overdose and death. The combination can also cause extreme drowsiness, which can lead to accidents and falls. In addition, alcohol can worsen anxiety and depression.^4,10,11

Long-term use of trazodone and alcohol can also result in the development of physical dependence and withdrawal symptoms. Trazadone withdrawal symptoms can include anxiety, agitation, and sleep problems. Instead of quitting cold turkey, people on the medication are advised to be tapered or gradually weaned off under the care of a physician.⁴

The acute alcohol withdrawal syndrome can be quite serious and can include symptoms such as insomnia, anxiety, increased body temperature, sweating, rapid pulse, nausea, and vomiting, as well as more severe complications such as agitation, hallucinations, delirium, and seizures. Left unmanaged, alcohol withdrawal can even be fatal due to the potential for grand mal seizures.¹²

People who have become dependent on alcohol may require supervised withdrawal management and medical detox—either as part of a standalone program or at the start of a rehabilitation program. Medical detox programs are staffed with healthcare professionals who can monitor the individual’s recovery during the withdrawal process and provide therapeutic interventions when needed.

Other Interactions

Alcohol is not the only drug that can potentially interact with trazodone. Some other drugs that may have contraindications to being used at the same time trazodone include:⁴

• Monoamine oxidase inhibitors (Marplan, Nardil): can increase the risk of serotonin syndrome.
• Central nervous system depressants (alcohol, benzodiazepines, and barbiturates): effects of these drugs, such as respiratory depression and drowsiness, may be heightened.
• CYP3A4 enzyme inhibitors (e.g., clarithromycin, nefazodone, ketoconazole): may lead to the person requiring a lower dose of trazodone; trazodone toxicity may occur at smaller-than-usual doses.
• CYP3A4 inducers (e.g., carbamazepine): may require a higher dose of trazodone; trazodone efficacy will be lowered at regular doses.
• Digoxin or phenytoin: concurrent trazodone use may lead to increased serum levels of these medications; monitoring of serum levels may be necessary to avoid toxicity.
• Warfarin (Coumadin): concurrent trazodone use can result in altered prothrombin times, leading to impaired blood clotting.
• Serotonergic medications: can cause serotonin syndrome.
• Non-steroidal anti-inflammatory drugs (NSAIDs), aspirin, or anticoagulants: can increase the risk of bleeding.

Whenever anyone is prescribed a product containing trazodone, they should provide their physician with a complete list of their prescription medications. The physician can best determine the potential for any adverse interactions with trazodone and adjust the medications accordingly.

Sources

1. Food and Drug Administration. (2017). DESYREL.
2. Mukherjee, S. (2012). Post-Prozac Nation: The Science and History of Treating Depression. The New York Times.
3. Fagiolini, A., Comandini, A., Dell’Osso, M., and Kasper, S. (2012). Rediscovering Trazodone for the Treatment of Major Depressive Disorder. CNS Drugs, 26(12), 1033-1049.
4. Food and Drug Administration. (2010). OLEPTRO.
5. Victoria State Government. (2012). Alcohol and the Brain.
6. Bowling Green State University. Effects of Alcohol.
7. Substance Abuse and Mental Health Services Administration. (2018). Key Substance Use and Mental Health Indicators in the United States: Results from the 2017 National Survey on Drug Use and Health.
8. Evans, E. and Sullivan, M. (2014). Abuse and misuse of antidepressants. Substance Abuse and Rehabilitation, 5, 107-120.
9. Tinsley, J., Olsen, M., Laroche, R., and Palmen, M. (1994). Fluoxetine Abuse. Mayo Clinic Proceedings, 69(2), 166-168.
10. University of Michigan Medicine. Trazodone.
11. Medline Plus. Trazodone.
12. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.