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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by saturn on February 27, 2007, at 22:53:55
My doc has several times mentioned, and even once prescribed trazadone.
I'm scared to death of priapism. I know it's something like 1 in 1000, but from experience with other psych meds I seem to be prone toward the more serious and rare complications.
My biggest fear is that I'd have priapism AND also be so sedated that I wouldn't be able to get the the hospital.
Has anyone else dealt with this? And how helpful is Trazadone for sleep, especially in terms of long-term usefulness, tolerance and withdrawal?
Thanks...Peace...Saturn.
Posted by med_empowered on February 28, 2007, at 1:11:36
In reply to Trazadone fear, posted by saturn on February 27, 2007, at 22:53:55
the priaprism thing for me was a deal breaker. My shrink was like "As an informed consent issue, I have to tell you there's very, very small risk of your priaprism.." at the time, I didn't know what it was, so we had this awkward convo about how it could
"cause an erection that you would be unable to...ummm..errr...'relieve" and I was like "Nope, gimme some ambien"So yeah. Just say NO. The risk is small--I've known plenty of guys on trazadone who still have functioning penises, but still; with so many other meds, WHY BOTHER?
If you have one of those "no controlled substances shrinks" and can't switch him/her out for a good doc, then suggest vistaril or remeron or..basically, anything that isn't trazadone.
Posted by yxibow on February 28, 2007, at 2:30:28
In reply to Trazadone fear, posted by saturn on February 27, 2007, at 22:53:55
> My doc has several times mentioned, and even once prescribed trazadone.
>
> I'm scared to death of priapism. I know it's something like 1 in 1000, but from experience with other psych meds I seem to be prone toward the more serious and rare complications.
I don't want to scare you any more but its more common than 1 in 1000. I don't know your age, but I believe priapisms are more dangerous in older individuals simply because of the age of the... organ. I had for quite some time doctors who believed that depressed people should receive Trazodone rather than true sleep drugs. I had at least 2 priapisms, maybe more, though I continued to use the drug. I solved them, um... yes, by standing on my head, so the blood drained away. And actually, it worked.
> My biggest fear is that I'd have priapism AND also be so sedated that I wouldn't be able to get the the hospital.
>
> Has anyone else dealt with this? And how helpful is Trazadone for sleep, especially in terms of long-term usefulness, tolerance and withdrawal?
Well there is a problem of escalation with Trazodone. One really shouldn't be taking more than 25-50mg or so for sleep. Eventually people (or at least myself) get used to it, and 50 becomes 75 and 150, and then you're into the adult dose range for Trazodone. At least the adult range that it was used for I guess in seriously depressed patients in the 70s because a dose of 300mg or so would put most people in a vegetative state I would think considering how much it hits one over the head like a brick. So you have to back off and restart again the Trazodone at a lower level.
I agree with the other poster, I don't think it should be used for sleep. There are other agents, if one must have to take an agent for a side effect, 7.5mg of Remeron (now don't go running to the fridge as it makes your appetite stronger) is a good and adequate dose for sleep. It also benefits because it can enhance REM sleep. You might have trippy dreams with it, at least at first.
If not Remeron, there is the third option of a very small dose of doxepin (Sinequan), which you have to give a weekend to get over with. I took it between these priapism episodes as a substitute and it knocked me out the whole weekend. You adjust to it though and the agent doesn't do that constantly. It is a tricyclic and an antihistamine (my mother takes it for angioedema because it blocks H1 and H2 and probably helps her insomnia) so it does carry some of the tendencies of TCAs though at sleep levels probably not that much.
But personally, I believe in the long term use of actual sleep agents [pseudo-benzodiazepine agents such as Ambien/AmbienCR, Lunesta (weaker, and oh so metally tasty), and Sonata (weakest)]. Yes, tolerance can build up with those, so again, one might have to back off and restart. I'm a terrible insomniac so I take Rozerem and Ambien.
Which brings me to Rozerem. That's another alternative and while some doctors might be scared that melatonin can lead to depression -- sensitive individuals might have a reaction, it is far more powerful than any OTC melatonin you can buy. This one has no dependence and if you havent had a bad reaction to melatonin I would seriously suggest it to your doctor.
-- tidingsJay
Posted by linkadge on February 28, 2007, at 8:21:37
In reply to Re: Trazadone fear » saturn, posted by yxibow on February 28, 2007, at 2:30:28
I wouldn't worry about it. For starters, you can take a very low dose to start, which would be unlikely to cause too much sedation to get to the hospital should such a side effect pop up (no pun intended)
You can slowly work your way up to a desired dose.
If it was going to cause this problem, I would think it would be mild at lower doses, and increase in sevarity as the dose goes up.So, a very low dose might cause the problem, but it would probably just go away without intervention.
Start at like 12.5 mg if you want.
Linkadge
Posted by Phillipa on February 28, 2007, at 11:32:30
In reply to Re: Trazadone fear, posted by linkadge on February 28, 2007, at 8:21:37
Well this is from a girl I know who took it for sleep at l50mg and it didn't sedate her not me. Love Phillipa
Posted by psychobot5000 on March 1, 2007, at 20:35:05
In reply to Re: Trazadone fear, posted by linkadge on February 28, 2007, at 8:21:37
1. There are remedies, like standing on your head.
2. Priapisms from Trazodone might be more common than 1 in 1000, but that doesn't necessarily mean that -potentially damaging- priapisms are that common.
3. Trazodone is not a powerful enough sedative to keep you from getting to the hospital. It's just not a knockout drug, in my experience or that I've heard of. It works as a 5HT receptor blocker and H1 blocker, and doesn't seem to have the potential to put people to sleep like benzodiazepines, ambien, lunesta, etc...
4. If, by some chance, it were especially sedating for you, you could just take a very small dose of the medication, and the chance of priapism would be essentially nil! Since you're worried, why not start with a very small dose, and assuming that's not adequate to help you sleep, move up! I really think trazodone is pretty benign in comparison to the side-effects from other meds!
I'd also suggest that, as someone who hates drug side-effects, it doesn't seem especially likely that you would suffer a strange one from trazadone, just because you've suffered (presumably unrelated) strange side-effects from other meds. It's a pretty particular, specific and disconnected side-effect, after all.
Best,
P-bot
Posted by saturn on March 1, 2007, at 22:05:59
In reply to Re: Trazadone fear, posted by med_empowered on February 28, 2007, at 1:11:36
> the priaprism thing for me was a deal breaker. My shrink was like "As an informed consent issue, I have to tell you there's very, very small risk of your priaprism.." at the time, I didn't know what it was, so we had this awkward convo about how it could
> "cause an erection that you would be unable to...ummm..errr...'relieve" and I was like "Nope, gimme some ambien"
>
> So yeah. Just say NO. The risk is small--I've known plenty of guys on trazadone who still have functioning penises, but still; with so many other meds, WHY BOTHER?Good point. Thanks. I think I'll stick with my Lunesta. Regards...Saturn.
> If you have one of those "no controlled substances shrinks" and can't switch him/her out for a good doc, then suggest vistaril or remeron or..basically, anything that isn't trazadone.
Posted by saturn on March 1, 2007, at 22:07:07
In reply to Re: Trazadone fear, posted by psychobot5000 on March 1, 2007, at 20:35:05
Posted by saturn on March 1, 2007, at 22:12:33
In reply to Re: Trazadone fear » saturn, posted by yxibow on February 28, 2007, at 2:30:28
> > My doc has several times mentioned, and even once prescribed trazadone.
> >
> > I'm scared to death of priapism. I know it's something like 1 in 1000, but from experience with other psych meds I seem to be prone toward the more serious and rare complications.
>
>
> I don't want to scare you any more but its more common than 1 in 1000. I don't know your age, but I believe priapisms are more dangerous in older individuals simply because of the age of the... organ. I had for quite some time doctors who believed that depressed people should receive Trazodone rather than true sleep drugs. I had at least 2 priapisms, maybe more, though I continued to use the drug. I solved them, um... yes, by standing on my head, so the blood drained away. And actually, it worked.
>
>
> > My biggest fear is that I'd have priapism AND also be so sedated that I wouldn't be able to get the the hospital.
> >
> > Has anyone else dealt with this? And how helpful is Trazadone for sleep, especially in terms of long-term usefulness, tolerance and withdrawal?
>
>
> Well there is a problem of escalation with Trazodone. One really shouldn't be taking more than 25-50mg or so for sleep. Eventually people (or at least myself) get used to it, and 50 becomes 75 and 150, and then you're into the adult dose range for Trazodone. At least the adult range that it was used for I guess in seriously depressed patients in the 70s because a dose of 300mg or so would put most people in a vegetative state I would think considering how much it hits one over the head like a brick. So you have to back off and restart again the Trazodone at a lower level.
>
>
> I agree with the other poster, I don't think it should be used for sleep. There are other agents, if one must have to take an agent for a side effect, 7.5mg of Remeron (now don't go running to the fridge as it makes your appetite stronger) is a good and adequate dose for sleep. It also benefits because it can enhance REM sleep. You might have trippy dreams with it, at least at first.
>
>
> If not Remeron, there is the third option of a very small dose of doxepin (Sinequan), which you have to give a weekend to get over with. I took it between these priapism episodes as a substitute and it knocked me out the whole weekend. You adjust to it though and the agent doesn't do that constantly. It is a tricyclic and an antihistamine (my mother takes it for angioedema because it blocks H1 and H2 and probably helps her insomnia) so it does carry some of the tendencies of TCAs though at sleep levels probably not that much.
>
>
> But personally, I believe in the long term use of actual sleep agents [pseudo-benzodiazepine agents such as Ambien/AmbienCR, Lunesta (weaker, and oh so metally tasty), and Sonata (weakest)]. Yes, tolerance can build up with those, so again, one might have to back off and restart. I'm a terrible insomniac so I take Rozerem and Ambien.
>
>
> Which brings me to Rozerem. That's another alternative and while some doctors might be scared that melatonin can lead to depression -- sensitive individuals might have a reaction, it is far more powerful than any OTC melatonin you can buy. This one has no dependence and if you havent had a bad reaction to melatonin I would seriously suggest it to your doctor.
>
>
> -- tidings
>
> Jay
Thanks Jay. Yeah, I think you're right, I should perhaps stick with Lunesta, which has on the whole served me well.I had also tried Rozerem for only about 5 days, perhaps I may give it another shot sometime. Thanks so much for the feedback. Regards...Saturn.
Posted by rjlockhart on March 2, 2007, at 23:56:19
In reply to Trazadone fear, posted by saturn on February 27, 2007, at 22:53:55
This is the end of the thread.
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