Trazodone

Drug Levels and Effects:




Summary of Use during Lactation:


Limited information indicates that trazodone levels in milk are low and would not be expected to cause any adverse effects in breastfed infants, especially if the infant is older than 2 months or when doses of 100 mg or less are used at bedtime for sleep.


Drug Levels:


Maternal Levels.

Six women who were 3 to 8 months postpartum were given 50 mg of trazodone orally and milk samples were taken for 30 hours after administration. Peak trazodone milk levels averaging about 110 mcg/L occurred 2 hours after the dose and milk levels declined with an average half-life of 7.5 hours (range 5.2 to 12.3 hours). The authors estimated that an exclusively breastfed infant would receive a dose of 0.005 mg/kg with this maternal dose or 0.65% of the maternal weight-adjusted dosage.[1] However, this study did not measure the active metabolite of trazodone in milk.

One woman who was 6.5 weeks postpartum and taking trazodone 75 mg daily had her milk measured at an unreported time after her dose. The trazaodone concentration in her milk was 40 mcg/L.[2]

Infant Levels.

Relevant published information was not found as of the revision date.


Effects in Breastfed Infants:


One infant whose mother took trazodone 200 mg daily for 12 weeks starting at 4 weeks postpartum was followed up at 12 months of age. No adverse effects on growth and development were found.[3]

One woman was 6.5 weeks postpartum and taking trazodone 75 mg, venlafaxine 75 mg and quetiapine 75 mg daily before conception, during pregnancy and during breastfeeding. Her breastfed infant's development was tested at 12 months of age with the Bayley Scales. Measurements were within normal limits on the mental, psychomotor and behavior scales.[2]

One exclusively breastfed 15-week-old infant was breastfed during maternal therapy with trazodone 100 mg daily and venlafaxine 150 mg daily. No adverse reactions were reported by the mother or in the medical records.[4]


Possible Effects on Lactation:


Relevant published information was not found as of the revision date.


Alternate Drugs to Consider:


Nortriptyline,Paroxetine,Sertraline


References:


1. Verbeeck RK, Ross SG, McKenna EA. Excretion of trazodone in breast milk. Br J Clin Pharmacol. 1986;22:367-70. PMID:3768252
2. Misri S, Corral M, Wardrop AA, Kendrick K. Quetiapine augmentation in lactation: a series of case reports. J Clin Psychopharmacol. 2006;26:508-11. PMID:16974194
3. Misri S, Sivertz K. Tricyclic drugs in pregnancy and lactation: a preliminary report. Int J Psychiatry Med. 1991;21:157-71. PMID:1894455
4. Newport DJ, Ritchie JC, Knight B et al. Venlafaxine in human breast milk and nursing infant plasma: determination of exposure. J Clin Psychiatry. 2009;70:1304-10. PMID:19607765



Substance Identification:




Substance Name:

Trazodone

CAS Registry Number:

19794-93-5

Drug Class:


  • Antidepressants

  • Serotonin Uptake Inhibitors


  • Administrative Information:




    LactMed Record Number:


    316


    Last Revision Date:


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