Trazodone For Opiate Withdrawal

In this article, we'll discuss the use of Trazodone for opiate withdrawal. Trazodone does effectively provide relief during opiate withdrawal. It is frequently used in combination with naloxone.

Trazodone was originally used as an antidepressant but is now more commonly used as a sleep aid.  Trazodone has some advantages over other drugs used to to mitigate opiate withdrawal symptoms. Importantly, Trazodone does not have any abuse liability or addictive potential, so individuals coping with opiate withdrawal need not fear that they're substance dependence is simply being transferred from one drug to another.

For this reason, Trazodone is unlike benzodiazepines (e.g., Xanax). Benzodiazepines are of limited use for alleviating prolonged opiate withdrawal due to the risk of another cycle of dependence and withdrawal.

Trazodone is probably most helpful at relieving the psychological symptoms of opiate withdrawal, including:*agitation/restlessness

  • anxiety
  • depression
  • insomnia

The psychological symptoms associated with opiate withdrawal are far worse than the physical symptoms (which tend to completely resolve within 3 days or 14 days for Methadone).

Trazodone For Opiate Withdrawal: Evidence From Primary Sources

Before using Trazodone for opiate withdrawal, it's a good idea to evaluate the evidence for benefit.

Here's a quick summary:

  • Both Trazodone and mianserin alleviated opiate withdrawal in an animal model1.

  • A 1979 paper reported complete blockade of acute opiate-withdrawal symptoms by trazodone2.

  • A comparative study of trazodone plus naloxone vs clonidine plus naloxone reported that, overall, Trazodone was effective as naloxone. The study concluded "No severe adverse effects were observed. We conclude that T(razodone) is effective, safe and well-tolerated in acute withdrawal from methadone." (Source: http://www.ncbi.nlm.nih.gov/pubmed/10812288).

About Trazodone Pharmacology

Trazodone is a: (1)  serotonin re-uptake inhibitor, (2) serotonin antagonist, (3) serotonin 5HT1A partial agonist, (4) alpha-adrenergic blocker.

Trazodone's ability to block alpha-adrenergic receptors probably contributes the most to its effectiveness at relieving opiate withdrawal. In this respect, Trazodone is similar to clonidine, which is also an alpha blocker.

Trazodone has antidepressant, anxiolytic (anxiety-reducing), and hypnotic effects. It's biological half-life is 7 hours.

An important side effect of trazodone is orthostatic hypotention. Orthostatic hypotention is a drop in blood pressure upon standing, which can lead to dizziness or feinting, if severe. This side effect is a consequent of alpha adrenergic receptor blockade. For this reason, Trazodone should not be combined with antihypertensive drugs or drugs that also have orthostatic hypotention as a side effect.

  1. http://www.ncbi.nlm.nih.gov/pubmed/12749364

  2. http://www.ncbi.nlm.nih.gov/pubmed/393279