Trazodone vs Xanax

What is Trazodone? What is Trazodone used for?

Trazodone is a Generic name for antidepressant drug that is prescribed to treat symptoms of depression. It belongs to the class of serotonin uptake inhibitors that works by increasing serotonin levels in the brain.

It is effective in patients with major depressive disorders and other types of depressive disorders. In general it is more useful in depressive disorders linked with insomnia and anxiety.  Trazodone may be also prescribed to treat anxiety, schizophrenia, or uncontrolled movements that may occur as a side effect of other medications.

A study from 2014, published in the American Journal of Geriatric Psychiatry found that trazodone is very effective in treating sleep disturbances in patients with diagnosed Alzheimer’s disease. Trazodone improves nighttime sleep without affecting thinking or brain function. Also, studies have showed that drug did not lead to daytime sleepiness or naps.

Trazodone can be also prescribed for the treatment of pain, fibromyalgia and bipolar disorder.  Trazodone is available in the form of immediate and extended release tablets in doses of: 50 mg, 100 mg, 150 mg and 300 mg.  FDA first approved trazodone in 1981 under the brand name Desyrel.

What is Xanax? What is Xanax used for?

Xanax is a Brand name for a medicine that contains short-acting benzodiazepine substance named alprazolam as an active ingredient. Alprazolam works by affecting brain chemicals known as neurotransmitters that are unbalanced in patients with different types of anxiety disorders. Xanax indications are: panic disorders with or without agoraphobia, generalized anxiety disorder and anxiety linked with depression.

It is available on the market in the form of immediate release tablet in doses of: 0.25, 1, 2 and 5 mg and in form of extended release tablet, named as Xanax XR in doses of 3 and 5 mg.  Xanax is manufactured by Pfizer.  FDA approved alprazolam in 1981. Xanax is also available as a generic drug.

How Trazodone and Xanax work in the body?

Trazodone works as a by binding to 5-HT2 receptor.  At high doses trazodone works as a serotonin agonist and in low doses as antagonist of same receptors. Trazodone’s antidepressant activity most likely is a result of serotonin reuptake inhibition, due to blockade of serotonin reuptake pump located on the presynaptic neuronal membrane.

If it is used for long term, it may also affect postsynaptic neuronal receptors. Trazodone sedative actions are likely the result of alpha-adrenergic antagonism and modest histamine blockade at H1 receptor. It is also weak antagonist of presynaptic alpha2-adrenergic receptors and strong antagonist of postsynaptic alpha1 receptors. Trazodone has no effects on the reuptake of norepinephrine or dopamine within the CNS.

Alprazolam, which is the active ingredient of Xanax works by binding to benzodiazepine BNZ-1  and  BNZ-2 receptors, responsible for sleep induction, anticonvulsant activity, memory functions and  motor coordination. Those receptors are coupled with GABAA receptors. By binding to them alprazolam increases GABA neurotransmitter inhibitory effects in the brain.

Difference and similarities between Trazodone and Xanax

is trazodone 50 mg like xanax

Trazodone and alprazolam from Xanax are mostly different but they do have some similarities.

The main difference between Trazodone and Xanax is their therapy group. Trazodone is antidepressant drug classified as serotonin antagonist and reuptake inhibitor, also known as SARI, while Xanax is anxiolytic drug from the benzodiazepine class. Their chemical structure is totally different. Chemically, trazodone is phenylpiperazine compound while alprazolam hasbenzodiazepine structure.

Their mechanism of action is also different. Trazodone is serotonin antagonist and reuptake inhibitor while Xanax is agonist of benzodiazepine’s receptors that works by increasing GABA activity.

So, trazodone works by improving mood, sleep, and appetite and life desire in general, while alprazolam has calming effects. Trazodone is mostly used to treat depressive disorders while Xanax is the best option for anxiety disorders.

However, both drugs can be used to treat both types of disorders. For example, trazodone is very efficient in treatment of insomnia linked with anxiety, while Xanax works very well in patients with anxiety disorders caused or linked with depression.

Xanax is very addicitive drug, while trazodone causes addiction in moderate fashion. According to one publication from the Journal of Clinical Psychiatry, in some cases trazodone is good to use in patients who are prone to abuse and addiction of benzodiazepines, or those who have a history of some drug or alcohol abuse.

Both medicines may cause different side effects, but some side effects are together for both of them such as drowsiness, dizziness, confusion and weight gain.

Both medicines may interact with alcohol increasing the risk of side effects to happen so it is never advisable to take them together.

Trazodone elimination from the body is biphasic process so it has 2 half-life times. Initial phase half-life t1/2 α is 3-6 hours and a terminal phase half-life t1/2 β of 5-9 hours. Alprazolam half life time is from 6.5 to 27 hours. According to this alprazolam stays longer in body than trazodone.

Which one is expensive, Trazodone or Xanax?

According to

  • The cost for trazodone tablet 50 mg is around $7 for a supply of 7 tablets,
  • The cost for trazodone tablet 100 mg is around $10 for a supply of 14 tablets
  • The cost for trazodone tablet 150 mg is around $15 for a supply of 14 tablets
  • The cost for trazodone tablet 300 mg is around $318 for a supply of 100 tablets
  • The cost for Xanax tablet 0.25 mg is around $323 for a supply of 100 tablets
  • The cost for Xanax tablet 0. 5 mg is around $400 for a supply of 100 tablets
  • The cost for Xanax tablet 1 mg is around $533 for a supply of 100 tablets
  • The cost for Xanax tablet 2 mg is around $902 for a supply of 100 tablets
  • Prices depend on the pharmacy you visit. Prices are for cash paying customers only and are not valid with insurance plans.

Trazodone and Xanax side effects

Trazodone may cause following side effects with following incidence:

  • Incidence >10%:

×          Blurred vision (5-15%)

×          Dizziness (20-28%)

×          Drowsiness (24-40%)

×          Dry mouth (15-34%)

×          Fatigue (6-15%)

×          Headache (10-33%)

×          Nausea/vomiting (10-21%)

  • Incidence 1-10%:

×          Constipation (7-8%)

×          Edema (3-7%)

×          Confusion (5-6%)

×          Disorientation (<2%)

×          Incoordination (2-5%)

×          Nasal congestion (3-6%)

×          Orthostatic hypotension (<7%)

×          Syncope (<5%)

×          Tremor (1-5%)

×          Weight change (5%)

×          Ejaculation disorder (2%)

×          Decreased libido (1-2%)

  • Incidence <1%

×          Priapism

×          Sedation

×          Alopecia

×          Anxiety

×          Acne

×          Anemia

×          Increased apetite

×          Diplopia

×          Insomnia

×          Urinary retention

×          Vertigo

Xanax may cause following side effects with following incidence:

×          Drowsiness (41%)

×          Depression (10-15%)

×          Headache (10-15%)

×          Constipation (10-15%)

×          Diarrhea (10-15%)

×          Dry mouth (10-15%)

×          Tachycardia (5-10%)

×          Confusion (5-10%)

×          Insomnia (5-10%)

×          Nausea/vomiting (5-10%)

×          Blurred vision (5-10%)

×          Nasal congestion (5-10%)

×          Hypotension (1-5%)

×          Syncope (1-5%)

×          Akathisia (1-5%)

×          Dizziness (1-5%)

×          Increased salivation (1-5%)

×          Nervousness (1-5%)

×          Tremor (1-5%)

×          Weight change (1-5%)

Does Trazodone and Xanax cause a weight changes?

Weight gain is one of many reported side effects that trazodone. Although exact mechanism of causing weight gain it is not fully understand, medical professionals believe that it is due to a different pharmacologic and biochemical actions of the drug. It is known that antidepressants can increase the appetite and the same goes to trazodone.

Usually, appetite loss is a symptom of depression, so when depression relieving is beginning or when it is relieved, the patient’s appetite is restored. In most cases weight gain occurs when depression symptoms are accompanied with loss of appetite, thus gradual increase in weight may be expected. Also in some patients, it is known that antidepressant drugs may lead to craving for certain types of foods such as carbohydrates and fat.

Many medical experts suggest that increased appetite is caused by increased serotonin levels. Clinical studies found that weight gain has been reported in 4.5 % of patients who were on trazodone therapy. Therefore weight gain is considered as a common side effect.

However in some cases trazodone may work opposite by causing weight loss. It is not known how this really happen. In many patients with depression eating is a defense mechanism. When their depression symptoms are relieved, their eating pattern becomes normal and gradual weight loss becomes evident.

But, in general, weight gain is a more common depression symptom hence weight loss can be a welcome change for some patients. Trazodone may cause gastrointestinal side effects such as nausea and loss of appetite and diarrhea, which may also lead to weight loss. These side effects often resolve with time. Every individual may react differently to trazodone and the best option is to discuss with your doctor any signs of weight change.

New studies revealed that health professional’s thought that the link between Xanax and weight gain is no coincidental. Most recent studies have been shown that patients who are taking Xanaxn are more likely to gain weight compared to those who not.

Studies that investigated link between Xanax administration and weight gain have been shown that patients who are on higher Xanax doses for panic attacks treatment were at an increased risk for weight gain.

Studies showed that 27.2% of the patients gained weight compared to 17.9% of those who did not take Xanax. Patients who administrated Xanax occasionally for the treatment of mild anxiety disorders experienced the same rate of gain as those who did not use it with 2.7%.

Mechanism that causes weight gain is still unknown, though it is suggested that sedative effects of this drug may be the crucial reason.  Xanax is a sedative drug that may inhibit patients’ desires to exercise and to burn calories. It is also known that this drug may lead to increased appetite and a slower overall metabolism.

What are Trazodone and Xanax interactions with other drugs?

Trazodone is known to interact with following drugs:

  • Blood Thinner or Anticoagulant drugs such as warfarin. Warfarin can result in either an increase or decrease in the prothrombin time.
  • Digoxin – Trazodone increases concentrations of digoxin in the blood thus increasing the risk causing arrhythmias. Digoxin levels in blood monitoring are necessary to avoid side effects.
  • MAO inhibitors and Other Antidepressant Drugs such as: phenelzine, isocarboxazide, selegiline, sertraline, paroxetine, fluoxetine, venlafaxine and others.
  • Antibiotic and Antifungal Drugs such as:  clarithromycin, levofloxacin, erythromycin, ketoconazole,  voriconazole,  itraconazole and other.  These drugs can increase the level of trazodone in the blood which can increase the risk of adverse effects.
  • Antihypertensive drugs such as diltiazem, verapamil and nifedipin.  These drugs may increase the level of trazodone in the blood increasing the risk of adverse effects
  • Antiarrhythmic drugs such as amiodarone, disopyramide, procainamide and quinidine.  These drugs can increase trazodone levels in the blood increasing the risk of adverse effects to happen.
  • Drugs for HIV/AIDS such as  amprenavir (Agenerase), atazanavir (Reyataz), fosamprenavir (Lexiva), indinavir (Crixivan), nelfinavir (Viracept), ritonavir (Norvir) and delavirdine (Rescriptor).  These drugs may increase the level of trazodone in the blood increasing the risk of adverse effects. Patients combining trazodone with ritonavir may experience side effects such as low blood pressure, nausea and syncope.
  • Antiepileptic drugs such as: carbamazepine and phenytoin.  Carbamezepine may decrease the trazodone amounts in blood, possibly reducing its intended pharmacologic effect. On the other hand, trazodone may increase the amount of phenytoin in the blood.
  • Diclofenac may increase the amount of trazodone in the blood, which may increase the risk of adverse effects.

Xanax may interact with following drugs:

  • Acid Reducers such as:  Prilosec, Prevacid, Zantac, Nexium, Tums or Rolaids, Mylanta and Maalox. These drugs may reduce the amount of acid in the stomach preventing Xanax from being absorbed into the bloodstream properly
  • Narcotic painkillers such as:  Codeine, Morphine, Lortab, Vicodin and OxyContin.  These drugs may cause sedating effects and increase drowsiness in patients.
  • Allergy and Cold Remedies such as:  Benadryl, Diabetic Tussin Night Time and Contac Day and Night Cold and Flu. Active ingredient in these products is diphenhydramine, which increases the risk of drowsiness.
  • OTC Sleep Aids such as: Simply Sleep, Melatonin, Unisom and. Sleep Ease.  Patients should avoid combining these drugs with Xanax as increased sedation may be experienced
  • Prescription sleep aids such as:  Lunesta, Ambien, Sonata and Halcion.  Taking these drugs with can increase the risk of severe side effects such as respiratory depression, a dangerously slow heart rate, coma and even death.
  • Medications Containing Propoxyphene such as:  Darvocet, Darvon, Balacet and Propacet.

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