www.medicinapropraxi.cz / Med. Praxi. 2025;22(2):94-97 / MEDICÍNA PRO PRAXI 97 PŘEHLEDOVÉ ČLÁNKY Využití trazodonu v praxi praktického lékaře využít v nižších dávkách jako hypnotikum či doplněk k jiné antidepresivní medikaci. Současně je však nutné dbát na jeho sedativní a kardiovaskulární účinky, monitorovat případnou ortostatickou hypotenzi, pečlivě zvážit rizika lékových interakcí a informovat pacienty o vzácném riziku priapismu při překročení terapeutických dávek 600 mg/d (vlastní praxe). Pro praxi praktického lékaře, který se často setkává s depresí, úzkostí či insomnií v kombinaci s dalšími somatickými obtížemi, nabízí trazodon dobře tolerované a bezpečné psychofarmakum. Vhodná edukace pacienta, opatrné zahájení léčby a pravidelná monitorace jsou klíčovými faktory pro maximální terapeutický přínos a minimalizaci rizik spojených s touto farmakoterapií. LITERATURA 1. WHO (World Health Organization). Depression and Other Common Mental Disorders: Global Health Estimates. Geneva: WHO; 2017. 2. Stahl SM. Mechanism of action of trazodone: a multifunctional drug. CNS Spectr. 2009 Oct;14(10):536-46. doi: 10.1017/ s1092852900024020. PMID: 20095366. 3. Mendelson WB. A review of the evidence for the efficacy and safety of trazodone in insomnia. J Clin Psychiatry. 2005 Apr;66(4):469-76. doi: 10.4088/jcp.v66n0409. PMID: 15816789. 4. Montalbano A, Mlinar B, Bonfiglio F, et al.Dual inhibitory action of trazodone on dorsal raphe serotonergic neurons through 5-HT1A receptor partial agonism and α1-adrenoceptor antagonism. PLoS One. 2019 Sep 26;14(9):e0222855. doi: 10.1371/journal.pone.0222855. PMID: 31557210; PMCID: PMC6763016. 5. Albert-Gasco H, Smith HL, Alvarez-Castelao B, et al. Trazodone rescues dysregulated synaptic and mitochondrial nascent proteomes in prion neurodegeneration. Brain. 2024 Feb 1;147(2):649-664. doi: 10.1093/brain/awad313. PMID: 37703312; PMCID: PMC10834243. 6. Oggianu E, Balestrieri C, De Berardis D, et al. Differential receptor occupancy in low- vs. high-dose trazodone: bridging the gap between sedation and antidepressant effect. Psychopharmacology Bulletin. 2022;52(4):55-63. 7. Oggianu L, Di Dato G, Mangano G, et al. Estimation of brain receptor occupancy for trazodone immediate release and once a day formulations. Clin Transl Sci. 2022 Jun;15(6):14171429. doi: 10.1111/cts.13253. Epub 2022 Mar 2. PMID: 35233913; PMCID: PMC9200067. 8. La AL, Walsh CM, van Zandt A, et al. Trazodone improves sleep and slows cognitive decline in mild Alzheimer’s disease. Alzheimer’s & Dementia. 2019;15(7S_Part_20):P1517. (Abstrakt). 9. Trittico (trazodone hydrochloride) [Souhrn údajů o přípravku]. (2020). Angelini Pharma Česká republika s. r. o. 10. Fagiolini A, Comandini A, Catena Dell'Osso M, et al. Rediscovering trazodone for the treatment of major depressive disorder. CNS Drugs. 2012 Dec;26(12):1033-49. doi: 10.1007/ s40263-012-0010-5. Erratum in: CNS Drugs. 2013 Aug;27(8):677. PMID: 23192413; PMCID: PMC3693429. 11. Češková E, Šilhán P. Možnosti léčby farmakorezistentní deprese v běžné klinické praxi. Praktické lékárenství. 2021;17(3):153-156. 12. Fava M, Rankin M, Alpert JE, et al. Management of sexual dysfunction associated with antidepressant use: a survey of clinical experience. J Clin Psychiatry. 2006;67(Suppl 1):23-28. 13. Ravindran LN, Stein MB. The pharmacologic treatment of anxiety disorders: a review of progress. J Clin Psychiatry. 2010 Jul;71(7):839-54. doi: 10.4088/JCP.10r06218blu. PMID: 20667290. 14. Morin CM, Colecchi C, Stone J, et al. The nature of antidepressant side effects in GAD and its impact on treatment outcome. J Clin Psychiatry. 2005;66(10):1370-1374. 15. Carpenter LL, Leonhard DE, Tyrka AR, et al. An open- -label study of trazodone augmentation of antidepressant therapy in treatment-resistant depression. J Clin Psychiatry. 1994;55(11):516-519. 16. Shelton RC, Tollefson GD, Tohen M, et al. A novel augmentation strategy for treating resistant major depression. Am J Psychiatry. 2001 Jan;158(1):131-4. doi: 10.1176/appi. ajp.158.1.131. PMID: 11136647. 17. Jaffer KY, Chang T, Vanle B, et al. Trazodone for Insomnia: A Systematic Review. Innov Clin Neurosci. 2017 Aug 1;14(78):24-34. PMID: 29552421; PMCID: PMC5842888. 18. Witte K, Entsuah R, Francois M. Trazodone: pharmacological profile and clinical experience reaffirming its value in depression treatment. Neuropsychiatr Dis Treat. 2015;11:1345-1351. 19. Ashton H. The diagnosis and management of benzodiazepine dependence. Curr Opin Psychiatry. 2005 May;18(3):24955. doi: 10.1097/01.yco.0000165594.60434.84. PMID: 16639148. 20. Tellone V, Rosignoli MT, Picollo R, et al. Effect of 3 Single Doses of Trazodone on QTc Interval in Healthy Subjects. J Clin Pharmacol. 2020 Nov;60(11):1483-1495. doi: 10.1002/jcph.1640. Epub 2020 Jun 2. PMID: 32488885; PMCID: PMC7586935. 21. Castro VM, Clements CC, Murphy SN, et al. QT interval and antidepressant use: a cross sectional study of electronic health records. BMJ. 2013 Jan 29;346:f288. doi: 10.1136/bmj.f288. PMID: 23360890; PMCID: PMC3558546. 22. Stewart JT, Cluff DL. Orthostatic hypotension: a practical approach. Am Fam Physician. 2020;101(5): 298-305. 23. Paholpak S, Chirawatkul A, Lertkadoung V, et al. Pharmacokinetics of trazodone in elderly patients. J Clin Psychopharmacol. 2002;22(2):153-160. 24. Kasper S, Olie JP. Safety and tolerability of trazodone prolonged-release in major depressive disorder: results from a pooled analysis of three clinical trials. Int Clin Psychopharmacol. 2011;26(6):323-333. 25. Boyer EW, Shannon M. The serotonin syndrome. N Engl J Med. 2005 Mar 17;352(11):1112-20. doi: 10.1056/NEJMra041867. Erratum in: N Engl J Med. 2007 Jun 7;356(23):2437. Erratum in: N Engl J Med. 2009 Oct 22;361(17):1714. PMID: 15784664. 26. Huang CJ, Chiu YC, Chen PJ, et al. Risk of falls and hip fractures associated with trazodone use in elderly patients: a nationwide population-based study. Medicine (Baltimore). 2017;96(2):e5796. 27. Garrone B, di Matteo A, Amato A, et al. Synergistic interaction between trazodone and gabapentin in rodent models of neuropathic pain. PLoS One. 2021 Jan 4;16(1):e0244649. doi: 10.1371/journal.pone.0244649. PMID: 33395416; PMCID: PMC7781482. 28. Post RM, Altshuler LL, Leverich GS, et al. Antidepressant treatment of bipolar depression: potential for increased switching and mood destabilization. J Clin Psychiatry. 2006;67(10):1723-1735. 29. Mazzu AL, Lasseter KC, Ferguson SM, et al. Effect of ketoconazole on the pharmacokinetics of trazodone in healthy volunteers. Clin Pharmacol Ther. 2000;67(2):215-221. 30. Hedges A, Jeppesen A. Trazodone and carbamazepine interaction. J Clin Psychopharmacol. 1992;12(2):138. 31. Montorsi F, Adaikan G, Becher E, et al. Priapism associated with antidepressant drugs: a systematic review. Int J Impot Res. 2003;15(5):338-341. 32. Gillman PK. Tricyclic antidepressant pharmacology and therapeutic drug interactions updated. Br J Pharmacol. 2007 Jul;151(6):737-48. doi: 10.1038/sj.bjp.0707253. Epub 2007 Apr 30. PMID: 17471183; PMCID: PMC2014120. 33. Nutt D. Trazodone: clinical pharmacology and therapeutic applications. Int Clin Psychopharmacol. 1988;3(3):253-264. 34. Wichniak A, Wierzbicka A, Jernajczyk W. Sleep and antidepressant treatment. Curr Pharm Des. 2012;18(36):5802-17. doi: 10.2174/138161212803523608. PMID: 22681161.
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