Trazadone and venlafaxine

[biba]

Hi - just hoping someone has some experience of this combination. I've been prescribed 150mg venlafaxine XL for a couple of years which has been supplemented with mirtazapine at intervals due to sleep difficulties. I always come off the mirtazapine as I hate the side effects (sedation, weight gain, grumpiness, looking tired all the time).

My Pdoc suggested trazadone and I've been taking 100mg for just over two weeks. I've been getting off to sleep fine but still waking between 4 and 5am. When I take promethazine (anti histamine), I sleep much better. My Pdoc has recommended putting trazadone up to 150mg but I'm a bit nervous as I've been feeling increased anxiety at times as well as a bit 'over-stimulated'.

I know the sedative effects of traz reduce at higher doses (like mirtazapine) but does it still help you sleep? Will the unpleasant side effects reduce over time?

I'm also wondering about increasing tge traz with a view to reducing/stopping the ven. My main issue is anxiety rather than depression so not sure if this would work.

Any insights into this would be gratefully received.

[panic_down_under]

My Pdoc suggested trazadone and I've been taking 100mg for just over two weeks. I've been getting off to sleep fine but still waking between 4 and 5am.

Trazodone gets less sedating as the dose increases and the usual dose for insomnia is 25-50mg (50mg is usually enough to block all (https://journals.sagepub.com/doi/pdf/10.1177/0269881117742101) the receptors that produce the hypnotic/sedation effect). 100mg is likely to be less effective. Its main advantage over meds like mirtazapine and promethazine is it's short half-life which usually lessens the risk of the sedation lasting into the next morning, but this could be working against you although maybe this won't be such an issue at lower doses.


When I take promethazine (anti histamine), I sleep much better.

If it isn't causing you any other issues then it might be the best sleep aid for you.


My Pdoc has recommended putting trazadone up to 150mg but I'm a bit nervous as I've been feeling increased anxiety at times as well as a bit 'over-stimulated'.

150mg is likely to be less effective for insomnia than 100mg. It is the dose at which it begins to have an antidepressive effect.


Will the unpleasant side effects reduce over time?

The anxiety/over stimulation? Probably.


I'm also wondering about increasing tge traz with a view to reducing/stopping the ven. My main issue is anxiety rather than depression so not sure if this would work.

Trazodone has a number of advantages. It is less likely to cause weight gain, or sexual dysfunction, might even enhance the libido. Whether it will be effective I can't say. It all comes down to how your biology meshes with it. You're likely to need to take at least 225mg with most on 300mg+ and be on a slow-release formulation to keep plasma levels above the sedation threshold. Stephen Stahl's Mechanism of Action of Trazodone: a Multifunctional Drug (PDF (http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.605.7477&rep=rep1&type=pdf)) is worth a read, imho.

[biba]

Thanks PDU - very helpful as always. I'm not sure I will able to tolerate the side effects but it's only been a couple of weeks at this dose. Do you think a higher dose will help side effects?
Are there any other mens that you know of that work well with venlafaxine and support sleep?

[panic_down_under]

I'm not sure I will able to tolerate the side effects but it's only been a couple of weeks at this dose. Do you think a higher dose will help side effects?

It will likely worsen them for a while.


Are there any other mens that you know of that work well with venlafaxine and support sleep?

Some recommend antipsychotics like quetiapine (Seroquel), but I'm not a fan. They can produce long-term side-effects. It sounds like promethazine is working well for you so why not stick with it?

[biba]

Thanks - I thought that sedative properties of promethazine diminish over time?

[panic_down_under]

Thanks - I thought that sedative properties of promethazine diminish over time?

They may, but this is also true of the alternatives.