Trazodone

INTRODUCTION

Indications

Major depression. Unlabeled Use: Insomnia, chronic pain syndromes, including diabetic neuropathy, and anxiety.

Action

Alters the effects of serotonin in the CNS. Therapeutic Effects: Antidepressant action, which may develop only over several weeks.

Adverse Reactions/Side Effects

CNS: drowsiness, confusion, dizziness, fatigue, hallucinations, headache, insomnia, nightmares, slurred speech, syncope, weakness. EENT: blurred vision, tinnitus. CV: hypotension, arrhythmias, chest pain, hypertension, palpitations, QT interval prolongation, tachycardia. GI: dry mouth, altered taste, constipation, diarrhea, excess salivation, flatulence, nausea, vomiting. GU: hematuria, erectile dysfunction, priapism, urinary frequency. Derm: rashes. Hemat: anemia, leukopenia. MS: myalgia. Neuro: tremor.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Assess blood pressure (BP) and compare to normal values (See Appendix F). Report changes in BP, either a sustained increase in BP (hypertension) or a problematic decrease in BP (hypotension) that results in dizziness and syncope.

• Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Report a rapid heart rate (tachycardia) or signs of other arrhythmias, including palpitations, chest discomfort, shortness of breath, fainting, and fatigue/weakness.

• Watch for signs of leukopenia (fever, sore throat, signs of infection) or unusual weakness and fatigue that might be due to anemia. Report these signs to the physician.

• Be alert for increased depression and suicidal thoughts and ideology, especially when initiating drug treatment, and in children and teenagers. Notify physician or mental health professional immediately if patient exhibits worsening depression.

• Be alert for confusion, slurred speech, hallucinations, or other alterations in mood and behavior (See Appendix D). Notify physician if these symptoms become problematic.

• Assess dizziness and drowsiness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician, and caution the patient and family/caregivers to guard against falls and trauma.

• Assess any muscle pain or tremor to rule out musculoskeletal pathology; that is, try to determine if pain is drug induced rather than caused by anatomic or biomechanical problems.

• If used to treat chronic pain syndromes or neuropathy, assess pain levels periodically to help document drug efficacy.

Interventions

• Guard against falls and trauma (hip fractures, head injury, and so forth), and implement fall-prevention strategies (See Appendix E).

• Because of the risk of cardiac arrhythmias and changes in BP, use caution during aerobic exercise and endurance conditioning Assess exercise tolerance frequently (BP, heart rate, fatigue levels), and terminate exercise immediately if any untoward responses occur (See Appendix L).

• To minimize orthostatic hypotension, patient should move slowly when assuming a more upright position.

• Help patient explore nonpharmacologic methods (exercise, counseling, support groups, and so forth) to reduce depression and ...