Alleviation of neuropathic pain by trazodone in rats

Abstract Neuropathic pain is generally characterised by an abnormal sensation (dysesthesia), an increased response to painful stimuli (hyperalgesia), and pain in response to a stimulus that does not normally provoke pain (allodynia). The present study was designed to investigate the effect of trazodone (5mg/kg and 10mg/kg) on peripheral neuropathic pain induced by partial sciatic nerve ligation in rats. Mechanical hyperalgesia, cold allodynia and thermal hyperalgesia were assessed by performing the pinprick, acetone, and hot plate tests, respectively. Biochemically, lipid peroxidation level and total calcium levels were measured. However, trazodone administration (5 and 10 mg/ kg i.p.) for 21days significantly diminished partial sciatic nerve ligation-induced neuropathic pain along with areduction in oxidative stress and calcium levels. The results of the present study suggest that trazodone is effective in attenuating partial sciatic nerve ligation-inducedpainful neuropathic states, which may be attributed to decreased oxidative stress and calcium levels.

Trazodone-induced delirium: case report / Delirio inducido por trazodona: reporte de caso

ABSTRACT Trazodone is used as an antidepressant in doses between 150 and 600 mg. At lower doses, it is commonly used to treat insomnia. There are few case reports about confusional symptoms as an undesirable side effect of this drug. We report a case of a patient who presented with delirium after prescription of trazodone 100 mg. She required hospitalisation but, shortly after discontinuation of trazodone, the symptoms disappeared without antipsychotic medication. Seven months after the episode, the patient remains asymptomatic.

RESUMEN La trazodona se usa como antidepresivo en dosis de 150-600 mg. En dosis más bajas, se usa comúnmente para tratar el insomnio. Hay pocos reportes de caso sobre síntomas confusionales como un efecto secundario indeseable de este medicamento. Se presenta el caso de una paciente que acudió con delirio después de la prescripción de trazodona 100 mg. La paciente requirió hospitalización pero, poco después de la interrupción de la trazodona, los síntomas desaparecieron sin medicación antipsicótica. A los 7 meses del episodio, la paciente permanecía asintomática.

TeleCondutas: avaliação e manejo da insônia / TeleGuides: evaluation and management of insomnia

A insônia é o mais prevalente dos transtornos do sono. É definida como a insatisfação com a qualidade ou a quantidade de sono, que ocorre a despeito de adequada oportunidade para dormir e que impõe ao indivíduo algum tipo de prejuízo durante o dia. A prevalência da insônia crônica em sociedades industrializadas é de 5 a 10%. Entre pessoas portadoras de doença crônica (psiquiátricas ou não) e idosos, a prevalência é significativamente maior. Trata-se de queixa frequente na Atenção Primária à Saúde (APS). Este material contempla as situações mais comumente associadas a insônia na APS, assim como o manejo inicial desta queixa. Está baseado em extensa revisão das evidências disponíveis na literatura, em boas práticas clínicas e adaptado à realidade brasileira, considerando as intervenções terapêuticas disponíveis. Esta guia apresenta informação que orienta a conduta para casos de avaliação e manejo da insônia no contexto da Atenção Primária à Saúde, incluindo: Avaliação Geral, Avaliação Objetiva, Avaliação e Manejo em situações específicas, Intervenções Não-Farmacológicas, Manejo Farmacológico na APS, Retirada de benzodiazepínico, Preocupações com uso de amitriptilina, Fármacos não recomendados na APS, Avaliação longitudinal da insônia, Fluxograma para avaliação e manejo da insônia.

Chronic dosing with mirtazapine does not produce sedation in rats

Objective: Sedation/somnolence are major side effects of pharmacotherapies for depression, and negatively affect long-term treatment compliance in depressed patients. Use of mirtazapine (MIR), an atypical antidepressant approved for the treatment of moderate to severe depression with comorbid anxiety disorders, is associated with significant sedation/somnolence, especially in short-term therapy. Nonetheless, studies with human subjects suggest that MIR-induced sedation is transient, especially when high and repeated doses are used. The purpose of this study was to explore the effects of acute and chronic administration of different doses of MIR on sedation in the rat. Methods: Assessment of sedation was carried out behaviorally using the rotarod, spontaneous locomotor activity, and fixed-bar tests. Results: A 15-mg/kg dose of MIR induced sedative effects for up to 60 minutes, whereas 30 mg/kg or more produced sedation within minutes and only in the first few days of administration. Conclusion: These results suggest that 30 mg/kg is a safe, well-tolerated dose of MIR which generates only temporary sedative effects.

An Analysis on Prescribing Patterns of Antidepressants and Their Associated Factors in Lung Cancer Patients

BACKGROUND: Depression is the leading cause of lowering the quality of life of cancer patients and lung cancer is the most likely to cause depression. It is necessary to find out depression-related factors in lung cancer patients. METHODS: The study was a retrospective cohort study using medical records, and was a non-equivalent comparison group design. It involved patients diagnosed of lung cancer at the Konkuk University Medical Center from January to December 2012. Between antidepressants prescription group and non prescription group, socio-demographic factors, clinical factors, treatment-related factors and other factors were analyzed statistically. RESULTS: Antidepressant prescription group consisted of 23 people and non-prescription group of 206 people. Prescription rate of quetiapine was the highest 47.8% (11/23), followed by escitalopram (43.5%, 10/23), amitryptyline and trazodone (30.4%, 7/23). The prescription group was prescribed with an average of 1.9 antidepressants. Antidepressants were prescribed after average of 248 days from lung cancer diagnosis and prescription period per patient was average 177.5 days. According to the result of univariate logistic regression analysis between 2 groups, factors such as number of outpatient visit, number of admission, days of hospitalization, sleep disorder, and comorbidity were found to be statistically significant (p < 0.05). However, According multivariate logistic regression analysis showed that number of admission, days of hospitalization and sleep disorder were statistically significant (p < 0.05) excluding comorbidity. CONCLUSION: About 10% of lung cancer patients had received a prescription for antidepressants after lung cancer diagnosis. A sleep disorder, number of hospitalization and length of stay were identified as factors influencing the prescribing antidepressants.

Trazodona en el trastorno del comportamiento del sueño MOR / Trazodone in REM sleep behavior disorder

A un varón adulto mayor, con un cuadro clínico documentado de trastorno comportamental del sueño MOR, inicialmente se le ofreció tratamiento farmacológico con clonazepam, recomendado por la literatura, pero se obtuvo mala adherencia por intolerancia a los efectos secundarios y la persistencia sintomática. Por ese motivo, se propuso el tratamiento con trazodona y se logró control sintomático completo, sin efectos adversos reportados por el paciente. Es claro que la trazodona no tiene indicación conocida para este tipo de trastornos, pero se consideró en este caso por su perfil farmacológico y se obtuvo un resultado clínico satisfactorio. Se plantea la necesidad de realizar mayores estudios que permitan documentar de manera suficiente la acción, la eficacia y la utilidad de esta molécula en casos como el ilustrado.

This case concerns an elderly man with a REM sleep behavior disorder, who was initially offered a pharmacological treatment with clonazepam, recommended by other articles, but with poor adherence due to its adverse reactions and persistence of symptoms. He was then offered a treatment with Trazodone was offered, achieving a complete remission of symptoms, with no reported side effects. It is clear that Trazodone has no known indication for this type of disorder; nevertheless, it was considered in this case because of its pharmacological profile, obtaining satisfactory results. Further research is needed in order to document thoroughly the mechanisms of action, efficacy and utility of this molecule in cases such as the one presented.

Outpatient treatment of sleep disorders in Alzheimer patients / Tratamento ambulatorial dos transtornos do sono em pacientes com doença de Alzheimer

Sleep disorders are common in patients with Alzheimer dementia and affect the quality of life of patients and of their caregivers. Despite the rising number of studies in the area, almost all of them are about non-pharmacological treatment. Our objective was to review the literature concerning pharmacological and non-pharmacological approaches to treat sleep disorders of elderly patients with Alzheimer dementia in the ambulatory setting. The treatments revised consisted of sleep hygiene and/or use of intense light coupled or not with use of melatonin, cholinesterase inhibitors, antipsychotics, hypnotics or antidepressants. In addition to the non-pharmacological measures, there is evidence that the use of trazodone may aid the treatment of sleep disorders of older individuals with Alzheimer dementia. More studies are necessary to examine the non-pharmacological and pharmacological treatments revised herein.

Os transtornos do sono são comuns nos pacientes com doença de Alzheimer e interferem na qualidade de vida do paciente e de seu cuidador. Apesar da alta prevalência desses transtornos, existe pouca evidência em relação ao seu tratamento. Nosso objetivo foi revisar a literatura em relação ao tratamento não farmacológico e farmacológico dos transtornos do sono nos idosos com doença de Alzheimer em comunidade. Os tratamentos incluídos consistiram na higiene do sono e/ou no uso da luz intensa, combinados ou não com o uso da melatonina, nos inibidores de acetilcolinesterases, antipsicóticos, hipnóticos ou antidepressivos. Para além das medidas não farmacológicas, há evidência de que o uso da trazodona é efetivo no tratamento dos transtornos do sono de pacientes com doença de Alzheimer. Mais estudos sobre as estratégias farmacológicas e não farmacológicas aqui revisadas ou outras são desejáveis.

Parkinsonismo induzido por trazodona durante o tratamento de hérnia discal lombar: relato de caso / Trazodone induced parkinsonism during lumbar disc herniation treatment: case report

A utilização de medicações psicoativas vem crescendo ao longo dos anos, sendo essencial o conhecimento de seus efeitos colaterais e interações medicamentosas. O desenvolvimento de distúrbios de movimento associados ao uso dessas substâncias é uma situação bastante desconfortável para o paciente, sendo essencial o diagnóstico adequado mediante forte suspeição. Relata-se o caso de um paciente que desenvolveu sintomas de parkinsonismo durante tratamento de hérnia discal lombar na vigência do uso de trazodona. É dada ênfase aos mecanismos de produção desse fenômeno e à sua condução clínica...

The use of psychoactive medications has been growing over years, being essential the knowledge of its side effects and interactions. The development of movement disturbances is a very uncomfortable situation for the patient, requiring a high suspicion for adequate diagnosis. A case of a patient who presented symptoms of Parkinsonism during use of Trazodone in the treatment of lumbar disc herniation is reported. Emphasis is given to the biological mechanisms of this phenomenon and its clinical conduction...

Prevalencia de interacciones potenciales evitables entre antidepresivos y otros medicamentos en pacientes colombianos / Prevalence of Avoidable Potential Interactions Between Antidepressants and Other Drugs in Colombian Patients

Objetivos: Determinar potenciales interacciones medicamentosas con antidepresivos y otros fármacos que pueden generar problemas relacionados con medicamentos mediante la búsqueda activa en bases de datos de pacientes afiliados al Sistema General de Seguridad Social en Salud. Métodos: Estudio descriptivo a partir de las bases de datos de dispensación de medicamentos de Audifarma S.A. a unos 4 millones de usuarios del pa ís; se hizo una revisión sistemática de potenciales interacciones de antidepresivos entre sí y con anticolinérgicos en los meses de octubre a noviembre y con tramadol durante todo el a ño 2010. Resultados: Se identificó un promedio mensual de 114.465 usuarios de antidepresivos. De estos, 5.776 (5,0 %) recibían dos antidepresivos simultáneamente y 178 (0,2 %), tres. La combinación más frecuente fue fluoxetina + trazodona (n = 3.235, el 56,9 % de los casos). A unos 1.127 (1,0 %) pacientes se les prescribió de manera simultánea un anticolinérgico. A 2.523 (2,1 %) usuarios se les dispensó al mismo tiempo tramadol, con lo que se elevaba el riesgo de aparición de síndrome serotoninérgico. Conclusiones: Las interacciones medicamentosas representan un riesgo potencial que muchas veces los médicos subestiman. La farmacovigilancia es una herramienta útil para optimizar recursos y prevenir resultados negativos relacionados con la medicación. Se recomienda considerar la búsqueda sistematizada para reforzar los programas de vigilancia de uso racional de medicamentos en el pa ís.

Objectives: To determine the possible drugs interactions with antidepressive agents in data bases of patients in the Health Insurance System of Colombia. Methods: From data bases of about 4 million users in Colombia, a systematic review of drugs dispensation statistics was made to identify drug interactions between antidepressive agents, cholinergic antagonists and tramadol in 2010. Results: We identified 114,465 monthly users of antidepressive agents. Of these, 5776 (5.0 %) received two, and 178 (0.2 %) received three antidepressive agents simultaneously. The most frequent combination was fluoxetine+trazodone (n =3235; 56.9 % of cases). About 1127 (1.0 %) patients were prescribed a cholinergic antagonist simultaneously; 2523 (2.1 %) users were dispensed tramadol at the same time, while raising the risk of serotonin syndrome. Conclusions: Drug interactions represent a potential risk that is often underestimated by physicians. Pharmacovigilance is a useful tool to optimize resources and prevent negative outcomes associated with medication. It is recommended that systematic search is made to enhance surveillance programs for the rational use of medicines in this country.

[Study the effect of buspirone and trazodone on hematological damage induced by long-term exposure to noise in mice]

The study investigated the effect of stress induced by long-term exposure to noise on body immunity through total white blood cell and lymphatic cell count, and on neutrophil-to-lymphatic cell ratio as a physiological marker of noise-induced stress in rats. In addition, the effect of both buspirone and trazodone in alleviating this negative outcome induced by noise was also investigated on 32 rats aged 90-100 days at the beginning of the study period. Results of the study was consistent with previous theories that noise may be considered as a causative agent which influences body's immune system when it reduces both total white blood cell and lymphatic cell count. Results also showed that the ration of neutrophil-to-lymphatic cell was increased as a result of long-term exposure to noise. Furthermore, the study presented a new evidence of antagonizing and therapeutic effect of buspirone and trazodone to stress-induced physiological damage

Comparison of Pharmacological Treatments for Burning Mouth Syndrome / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Burning mouth syndrome (BMS) refers to a collection of symptoms of patients who complain about burning sensation of their mouths without any specific causes. Although this is not a rare disease, the etiology and effective treatment are not well established. We tried to compare the efficacy and side effects of the agents that are reported to be relatively effective to BMS. SUBJECTS AND METHOD: Fifty-one patients who were diagnosed as BMS were chosen as candidates. Trazodone, Paroxetine, Clonazepam, and Gabapentin, which were known to be effective medicines for BMS in previous research were prescribed randomly. We prescribed medication for two weeks and evaluated patients for the effect and side effects at the end of the treatment. The medication was prescribed for 2 more weeks and the patients were evaluated again. RESULTS: Three of 11 (27.3%) patients were prescribed Trazodone, 8 of 12 (66.7%) Paroxetine, 8 of 14 (57.1%) Clonazepam and 12 of 14 (85.7%) Gabapentin. Q showed improvements after 4 weeks of medication. The differential effectiveness among the medications was not significant, except for the inferiority of Trazodone. Five of 11 (45.5%) patients who had been prescribed Trazodone, 2 of 12 (16.7%) who had been prescribed Paroxetine, 2 of 14 (14.3%) who had been prescribed Clonazepam, 2 of 14 (14.3%) who had been prescribed Gabapentin complained of side effects during 4 weeks of medication. CONCLUSION: We can expect high success rates of treatment for burning mouth syndrome with Paroxetine, Clonazepam and Gabapentin. A further study for long term outcomes and side effects in large groups is warranted.

Yimusake alone or combined with trazodone hydrochloride for primary premature ejaculation / 中华男科学杂志

<p><b>OBJECTIVE</b>To study the clinical effects of the Chinese drug Yimusake, used alone or in combination with trazodone hydrochloride, on primary premature ejaculation (PE).</p><p><b>METHODS</b>Sixty-eight primary PE patients were randomized to a control (n=32) and an experimental group (n=36), the former treated with Yimusake 1 tablet (50 mg) pre day, and the latter with 1 tablet of trazodone hydrochloride (50 mg) pre day in addition, both given orally after supper and for 4 weeks, followed by observation of the therapeutic effects.</p><p><b>RESULTS</b>Eighteen cases (56.25%) responded in the control and 25 (69.44% ) in the experimental group, with statistically significant difference between the two groups (P<0.05).</p><p><b>CONCLUSION</b>Yimusake combined with trazodone hydrochloride is highly efficacious for primary PE.</p>

Trazodone for the treatment of sleep disorders in dementia: an open-label, observational and review study / Trazodona para o tratamento de distúrbios do sono em demência: um estudo aberto, observacional e de revisão

Sleep disorders (SD) in patients with dementia are very common in clinical practice. The use of antidepressants with hypnotic actions, such as trazodone, plays an important role in these cases. The aim of this study is to present a profile of the use of trazodone in demented patients with SD, as well as a review of trazodone hydrochloride in SD. We evaluated 178 elderly patients with Alzheimer's disease and other dementias, clinically presenting SD and treated with hypnosedative medications. In the one-year period comprising the study, 68 (38.2 percent) of the 178 had sleep disorders. Most patients (114; 64 percent) had a diagnosis of Alzheimer's disease. Approximately 85 percent of patients with SD used hypnosedative drugs. Trazodone was the most commonly used drug among patients (N = 35), with an effectiveness of 65.7 percent. Trazodone has been shown to be a good option for treatment of the elderly with dementia and associated SD.

Distúrbios do sono (DS) em pacientes com demência são muito comuns na prática clínica. O uso de antidepressivos com ação hipnótica, como a trazodona, tem um papel importante nesses casos. O objetivo desse estudo é apresentar um perfil do uso da trazodona em pacientes com demência e com DS, bem como revisar o cloridrato de trazodona no DS. Nós avaliamos 178 idosos com doença de Alzheimer (DA) e outras demências, clinicamente apresentando DS e que foram tratados com medicações hipnossedativas. No período de um ano de estudo, 68 (38,2 por cento) tiveram DS. A maioria (114; 64 por cento) tinham diagnóstico de DA. Aproximadamente 85 por cento usaram fármacos hipnossedativos. A trazodona foi a mais utilizada (N=35), com evidência de melhora de 65,7 por cento. A trazodona mostrou-se ser uma boa opção no tratamento de idosos com demência e DS associado.

Comparison of efficacy and adverse effects of trazodone and paroxetine in major depressive disorder

It is an open-label comparative study, conducted at the Department of Pharmacology and Therapeutics, Basic Medical Sciences Institute, Jinnah Postgraduate Medical Centre, Karachi. The study comprised of two drugs of different groups; total eighty adult patients were enrolled [44 female and 36 male] from the department of psychiatry. Enrolled patients received trazodone 50 mg daily which was gradually increased to 150 mg in divided doses and paroxetine 20 mg daily for a period of 90 days. The results revealed that paroxetine is more effective and has less adverse effects than the trazodone. There was significant improvement in symptoms of sexual disturbance and weight loss of major depressive disorder patients receiving paroxetine

Efficacy of nicotine patch in combination with trazodone in smoking cessation

Treatment for tobacco dependency involves a combination of behavioral therapy, antidepressants, and nicotine replacement therapy. This study was conducted in order to compare the outcome of smoking cessation by using each of the four forms of nicotine replacement therapy [NRT] among participants using Trazodone tablet 50 mg. In this non-randomized quasi-experimental study the efficacy of four mentioned forms of nicotine replacement therapy [NRT] including patches, gums and microtabs and two forms of NRT together was evaluated. Smoking cessation while using Trazodone was also studied. All the smokers who referred to the smoking cessation clinic of Iranian National Research Institute of Tuberculosis and Lung Diseases [NRITLD], Tehran, Iran from Oct. 2005 to Oct. 2007 entered the study. They attended 4 weekly sessions followed by 2 sessions in the next 12 months. A total of 286 subjects participated in this study. Trazodone was prescribed for them and 253 used at least one form of NRT. There were 181 [74.6%] males. The mean age was 42.43 +/- 13.4 yrs. Thirty three cases selected nicotine patches, 99[39.4%] used nicotine gums, 64[25%] chose microtabs and 57[23%] preferred using two types of NRT simultaneously. A total of 152 participants [60%] quit smoking at the fourth session. At the fourth session, it was proved that nicotine patches had the highest success rate and were most efficient for quitting smoking [94%]. Also, after 6 and 12 months follow-up it was found that nicotine patches were most effective for abstinence. Nicotine patches used in combination with Trazodone tablets could result in higher success rates for smoking cessation

Effect of acupuncture treatment of relieving depression and regulating mind on insomnia accompanied with depressive disorders / 中国针灸

<p><b>OBJECTIVE</b>To compare the therapeutic effects of insomnia accompanied with depressive disorders treated by acupuncture of relieving depression and regulating mind and oral administration of Trazodone.</p><p><b>METHODS</b>Sixty-five cases were randomly divided into a acupuncture group (33 cases) and western medication group (32 cases). In acupuncture group, Shenmen (HT 7), Baihui (CV 20), Hegu (LI 4) and Taichong (LR 3) were selected. In western medication group, Trazodone was applied with oral administration for 4 weeks. The curative effect comparison was carried on by Pittsburgh Sleep Quality Index (PSQI), Self-Rating Depression Scale (SDS), and Side Effect Rating Scale (SERS) of Asberg.</p><p><b>RESULTS</b>The cured and markedly effective rate of 72.7% (24/33)in acupuncture group was superior to that of 46.8% (15/32) in western medication group; after treatment, the scores of all items and the total cumulative scores of PSQI and SDS of both groups were reduced (P < 0.01, P < 0.05), of which, the sleep quality and daytime function evaluation in acupuncture group reduced more obviously than those in western medication group (both P < 0.05); the SERS scores of Asberg in western medication group were higher than those in acupuncture group.</p><p><b>CONCLUSION</b>Acupuncture treatment of relieving depression and regulating mind is superior to Trazodone with oral administration for sleep quality and daytime function, with milder adverse reactions.</p>

The use of an antagonist 5-HT2a/c for depression and motor function in Parkinson' disease / Uso de um antagonista 5-HT2a/c na depressão e na função motora de pacientes com doença de Parkinson

OBJECTIVE: To test the ability of a 5HT2a/c (trazodone) antagonist, to improve depression and motor function in Parkinson' disease (PD). METHOD: Twenty PD patients with and without depression were randomly assigned to receive trazodone (group 1) or not (group 2). They were evaluated through UPDRS and Hamilton Depression Rating Scale (HAM-D). RESULTS: For the UPDRS the mean score of group 2 was 33.1 ± 19.7 and 37.1 ± 18.0 at the end. For the group 1, the corresponding scores were 31.4 ± 11.3 and 25.9 ± 13.7. The variations in the Mann-Whitney test were 0.734 at the initial moment and 0.208 at the final moment. The variation in the comparison of the initial moment with the final moment was 0.005 providing statistical significance. For the HAM-D, the mean score went up 4 points in group 2, contrary to a 5.5 points decrease in group 1. CONCLUSION: Data analysis shows that this agent significantly improves depression, but the motor function improved only in the depressed patients. Because of the known anti-dopaminergic property of the 5-HT2c receptors, a possible approach for depression in PD could be the use of 5-HT2c antagonists, similarly to the use of atypical neuroleptics in case of psychotic symptoms.

OBJETIVO: Avaliar a eficácia de um antagonista 5-HT2a/c (trazodona) na depressão e na função motora de pacientes com doença de Parkinson (DP). MÉTODO: Vinte pacientes com DP com e sem depressão foram randomizados e divididos em 2 grupos com e sem a trazodona (grupos 1 e 2). Foram avaliados pela escala UPDRS e a de depressão de Hamilton (EDH). RESULTADOS: A média inicial do grupo 2 na UPDRS foi 33,1 ± 19,7 no momento inicial e 37,1 ± 18,0 no final. Para o grupo 1 as médias correspondentes foram 31,4 ± 11,3 e 25,9 ± 13,7. As variações no teste de Mann-Whitney foram 0,734 no momento inicial e de 0,208 no final. A variação na comparação entre o momento inicial e o final foi 0,005, caracterizando significância estatística. Para a EDH a média subiu 4 pontos no grupo 2, e desceu 5,5 pontos no grupo 1. CONCLUSÃO: A análise estatística revelou melhora da depressão, porém o benefício na função motora foi obtido apenas entre os deprimidos. Do mesmo modo que os neurolépticos atípicos atuam nos sintomas psicóticos, a ação secundária dopaminérgica do antagonista 5-HT2c pode ser útil no tratamento da depressão na DP.

Effect of trazodone on sleep bruxism in children and adolescents 6-18 years of age, a pilot study

Sleep bruxism is a common sleep disorder with unclear etiology and no definitive treatment. Recent suggested medications are not often practically used due to their numerous limitations. Based on the fact that sleep bruxism occurs most often in the second stage of non-REM sleep, this study aimed to assess the effect of trazodone on sleep bruxism. This pilot study was conducted as a before-after design on 28 children and adolescents with 6-18 years of age suffering from sleep bruxism referring by children and adolescents mental health clinic, children dental specialists and pediatricians. The treatment started with 0.5mg/kg/day. In non-responders, it was weekly added by 0.5 mg/kg/day [with optimum of 2 mg/kg/day]. Frequency of bruxism and related morning face/jaw pain were assessed daily from two weeks before [baseline] to four weeks after starting the intervention by the parents/roommate. Findings showed a significant reduction in the frequency of both bruxism and related morning pain from baseline to the 2nd and the 4th weeks of the intervention [P<0.001]. Minor side effects such as drowsiness, nausea and dry mouth were seen among approximately one-third of the patients. These side effects were self-limited and tolerable. Trazodone could be effective in reducing the frequency of sleep bruxism and its related morning face/jaw pain. Well-designed placebo-controlled trials are needed to confirm the results

Combination Therapy of Sildenafil with Trazodone in Erectile Dysfunction Patients with Decreased Libido and Normal Serum Testosterone / 대한남성과학회지

Purpose: This study was done to assess the therapeutic effect of trazodone, an antidepressant agent in combination with sildenafil in patients with erectile dysfunction (ED) and decreased libido with normal serum testosterone level. Materials and Methods: From March 2005 to February 2006, 90 patients with ED complaining of decreased libido but whose serum testosterone level was within normal range were screened and enrolled in this study. The subjects were randomly treated by sildenafil only (group 1) and combination of sildenafil with trazodone (group 2). Patients received trazodone for at least 3 consecutive months, with daily doses starting at 50 mg. By intention-to-treat basis, the period of study was extended by 9 month. The intention-to-treat population included 39 sildenafil recipients and 35 sildenafil with trazodone recipients. The patients were asked to make up two questions, Q1: 'Did you experience improvement of erection after treatment?' and Q2: 'Did you experience improvement of libido after treatment?' and the change of International index of erectile function (IIEF) scores before and after the treatment were analyzed to assess the efficacy of treatment. Results: After 3 month treatment period, 70% of group 1 and group 2 answered 'yes' to Q1. Twenty seven percents of group 1 and 51% of group 2 answered 'yes' to Q2 and 20% of group 1 and 24% of group 2 answered 'yes' to both Q1 and Q2. In the intention-to-treat population, seventy-two percents of group 1 and 71% of group 2 answered 'yes' to Q1 and 28% of group 1 and 52% of group 2 answered 'yes' to Q2, 21% of group 1 and 26% of group 2 answered 'yes' to both Q1 and Q2. The change of IIEF scores before and after the treatment at 3 month and 9 month showed similar results. Both group 1 and group 2 showed significant improvement on scores of IIEF-5 and question 15 of IIEF after treatment (p<0.01). Meanwhile, only group 2 showed significant improvement on question 11 and 13 of IIEF after the treatment compared to group 1 (p<0.05). Two patients with high dose of trazodone complained of headache and drowsiness, but the symptoms disappeared by dose reduction. Conclusions: The combination therapy of trazodone with sildenafil increased libido and sexual satisfaction on patients with ED. Therefore, combination of trazodone with sildenafil might be considered in ED patients of decreased libido with normal serum testosterone level rather than sildenafil monotherapy.