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Safety of Trazodone as a Sleep Agent for Inpatients

Received April 16, 2004; accepted Nov. 15, 2004. From the Department of Psychiatry, Johns Hopkins Hospital. Address correspondence and reprint requests to Dr. Jayaram, Department of Psychiatry, Johns Hopkins Hospital, Meyer 4-181, 600 North Wolfe St., Baltimore, MD 21287; gjayara1{at}jhmi.edu (e-mail).

Trazodone, an atypical antidepressant with relatively low anticholinergic and cardiac conduction effects, offers useful augmentation to classic antidepressant drugs, notably selective serotonin reuptake inhibitors. One rare but serious side effect of the drug is priapism, the urological emergency in which the cavernosa of the penis become painfully engorged in the absence of sexual stimulation. The authors present what appears to be the first published case of priapism requiring urologic intervention after a single 100-mg dose of trazodone. In addition to a discussion of the history and physiology of trazodone and priapism, the authors present a profile of patients who present a safety risk in treatment.

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