Advice for all antidepressants
You should read our advice for all antidepressant switching before applying that to individual trazodone switches below.
- Establishing whether a person needs to switch their antidepressant
- Choosing an antidepressant to switch a person to
- Planning and agreeing an antidepressant switching strategy
- Monitoring a person during and after antidepressant switching
Trazodone to agomelatine
Cross-taper
Cross-tapering can usually be undertaken cautiously over 2 to 4 weeks, the speed is determined by individual tolerability.
There is limited experience with this switch so extra caution is required. Although interactions are not expected, agomelatine is not expected to mitigate discontinuation reactions from stopping trazodone.
Trazodone to moclobemide
Taper, washout and switch
Gradually reduce the dose of trazodone and stop; wait 7 days before starting moclobemide.
Cross-tapering is not recommended due to the high risk of serotonin syndrome.
Trazodone to monoamine oxidase inhibitors (MAOIs)
Switching to an MAOI is always a complex switch and you should follow specialist advice.
Taper, washout and switch with specialist advice
Gradually reduce the dose of trazodone and stop; wait 7 to 14 days before starting the MAOI. The specialist will advise the duration of the washout period on a case-by-case basis taking into consideration the MAOI being started.
Cross-tapering is not recommended due to the high risk of serotonin syndrome.
Trazodone to selective serotonin reuptake inhibitors (SSRIs)
Cross-taper
Cross-tapering can usually be undertaken cautiously over 2 to 4 weeks, the speed is determined by individual tolerability.
Additional caution when switching to fluoxetine or paroxetine
If switching to fluoxetine or paroxetine, caution is required because they are potent inhibitors of the liver enzyme CYP2D6 which is involved in the metabolism of trazodone. Although trazodone is being withdrawn, you should still be aware of the risk of raised trazodone levels in the body when they are administered together.
Trazodone to serotonin and noradrenaline reuptake inhibitors (SNRIs)
Cross-taper
Cross-tapering can usually be undertaken cautiously over 2 to 4 weeks, the speed is determined by individual tolerability.
Trazodone to tricyclic antidepressants (TCAs)
Cross-taper
Cross-tapering, starting with a low dose TCA can usually be undertaken cautiously over 2 to 4 weeks, the speed is determined by individual tolerability.
Switching to dosulepin requires specialist advice and should not be done in primary care due to the increased cardiac risk and toxicity in overdose.
Trazodone to vortioxetine
There is limited experience with this switch so extra caution is required to avoid serotonin syndrome.
Cross-taper
Cross-tapering can usually be undertaken cautiously over 2 to 4 weeks, the speed is determined by individual tolerability.
Taper, washout and switch
Alternatively, gradually reduce the dose of trazodone and stop; wait for a period before starting vortioxetine. Clinicians should decide the duration of the washout period on a case-by-case basis.
Deciding on the switching strategy
Our guidance on Planning and agreeing an antidepressant switching strategy will help you decide which switching strategy to choose.
More advice on individual switches
We have further advice on how to switch between individual antidepressants of different types. Browse our collection below.
- Switching strategies for antidepressants
- MAOI to other antidepressants: switching in adults
- Moclobemide to other antidepressants: switching in adults
- Vortioxetine to other antidepressants: switching in adults
- SNRIs to other antidepressants: switching in adults
- Agomelatine to other antidepressants: switching in adults
- Mirtazapine to other antidepressants: switching in adults
- Tricyclics to other antidepressants: switching in adults
- SSRIs to other antidepressants: switching in adults