Are There Dangers of Mixing Trazodone with Alcohol?

Trazodone is a medication used to treat mental illness, specifically depression and anxiety. Trazodone aims to increase the levels of noradrenaline and serotonin in the brain to level out the chemical imbalance that is causing the mental condition.

Trazodone is a tetracyclic antidepressant, approved by the FDA to treat depression. Trazodone is a SARI, also known as a serotonin receptor antagonist and reuptake inhibitor. SARIs work to increase the effect of serotonin in the central nervous system.

Trazodone and other SARIs do this by reducing the reuptake of serotonin, and therefore increasing the activity of serotonin throughout the brain.

The right balance of serotonin, the chemical that carries messages from the brain to the body, is vital for mental health. Noradrenaline is an organic chemical in the brain that aids its function and hormonal balance.

An imbalance of both of these chemicals in the brain, along with environmental and genetic factors, may result in a mental illness such as depression or anxiety. [1]

Trazodone medication comes in the form of tablets, liquid, or tablets and is not available over the counter. [2] You may be prescribed trazodone if you are diagnosed with depression, anxiety, or both.

The symptoms for these illnesses can vary widely but they often present as the following:

• Low moods
• Sadness
• Insomnia
• Poor concentration
• Hopelessness
• Loss of interest
• Low self-esteem
• Feelings of impending doom
• Lack of motivation
• Feeling suicidal
• Intense worry and fear

Symptoms of mental illness may persist for months or years and may be detrimental to people’s lives. Mental health has both mental and physical symptoms, such as stomach aches, loss of libido (sex drive), heart palpitations, and shaking.

Mental health may also affect your social life, leading to isolation and neglecting interests and passions.

Doctors may prescribe Trazodone following unsuccessful attempts of other antidepressants. This may be because they have not worked or because they have had negative side effects on the patient.

It may take around 1 to 2 weeks before patients feel the effects of trazodone, and it could be up to 2 months before patients feel all of the benefits.

There are different topics you must discuss with a doctor before you have been prescribed trazodone, to be prescribed the right dose and understand the side effects:

• Symptoms of the condition
• Past ‘tried and tested’ medication
• Side effects
• All medical issues (physical and mental)
• If you are pregnant or breastfeeding
• If you use drugs or alcohol

It is vital to disclose the amount of alcohol you consume on a weekly basis due to the interaction between medication and alcohol in the body. These interactions can alter two things, the way the medication is metabolised, and its side effects.

Alcohol on the Nervous System

Alcohol is the most used and most abused substance in the world. Medically, alcohol is a depressant and acts on the brain’s neurotransmitters. However, most people tend to drink in excess due to the feeling of relaxation and the sedative effect of alcohol.

These effects, which boost confidence and reduce anxiety, do not last long. In the long term, alcohol induces anxiety and depression and exacerbates any underlying mental health problems. [3]

Alcohol, whilst affecting neurotransmitters, also affects the body:

• Reduced reaction times
• Blurry vision
• Confusion
• Poor coordination
• Impaired judgement
• Decreased alertness
• Drowsiness

When alcohol is consumed, the body begins to metabolise the alcohol in the stomach. This ‘first pass’ metabolism is where enzymes in the stomach metabolise alcohol (ADH, or alcohol dehydrogenase). The rest of the alcohol is absorbed by the gastrointestinal tract into the blood. [4]

This first stage of alcohol metabolism occurs after a low alcohol concentration enters the blood. This is usually around 2 drinks for someone of 70kg.

Only around 10% of the alcohol ingested is metabolised in the stomach, as the more alcohol that someone consumes, the less that is metabolised in the stomach.

Alcohol is mostly metabolised in the liver, and transported to the liver by the portal vein. Alcohol is metabolised in the liver by cytochrome P450 and ADH. [5] Any alcohol left will travel around the body, and if unabsorbed, it will work its way back to the liver to be metabolised once again.

Alcohol distribution and metabolism differ from person to person according to sex, age, weight, and height. Females tend to have a lower water level, and therefore have higher blood alcohol concentration than males do.

Other factors may also affect the levels of alcohol concentration in the blood: [6] [7] [8]

• Rate of alcohol consumption (how fast someone consumed alcohol)
• Consumption of food before or during drinking
• Type of alcohol
• Diet
• Age
• Smoking
• Drugs
• Time of day
• Genetics
• Medication

The Medical Interactions Between Alcohol and Medication

Firstly, research has shown that some medication causes an increase in levels of blood alcohol concentration, leaving patients with increased levels of intoxication. Some forms of medication will prevent first-pass metabolism in the stomach.

Not only can this lead to a risk of overdose, but it can also increase the risk of injury and accidents. [9] [10]

When consumed, antidepressants such as trazodone are not associated with euphoric highs, but instead associated with their sedative effect. [11]

This has led to a potential for drug abuse, consuming antidepressants for their alcohol-like sedative effects. That being said, most people prescribed antidepressants do not abuse them, and overdoses concerning trazodone are not common, but they have occurred in the past.

There are two types of interactions that may occur within the body if alcohol is consumed whilst a patient is taking prescribed medication such as trazodone.

Studies have shown that the following interactions occur in the body:

1. Pharmacokinetic interaction
2. Pharmacodynamic interaction

A pharmacokinetic interaction is where the alcohol interferes with the metabolism of the medication. This interaction may alter the absorption, elimination, or distribution of a drug which could increase or decrease drug concentration.

This will usually occur in the liver, metabolising both medication and alcohol using similar enzymes (e.g., ADH).

The second interaction, a pharmacodynamic interaction, enhances the effects of the medication on the central nervous system.

For example, most medications will have a sedative side effect, inducing drowsiness. Alcohol has the same effect.

Therefore, mixing them both will result in enhanced side effects and substantial impairment of cognitive function.

The Dangers of Mixing Alcohol and Anti-depressants

It is considered to be very dangerous to mix antidepressants like trazodone with alcohol. As mentioned, trazodone amplifies the effects of alcohol, leading to increased levels of intoxication.

Not only does mixing affect the body but mixing alcohol with medication may worsen any pre-existing mental health disorders.

Using both alcohol and trazodone at the same time for a long period can result in dependency and increased tolerance. Alcohol may therefore prevent the workings of the medication, and mental illnesswill continue.

Other drugs may interact with trazodone, causing negative side effects:

• Most central nervous system depressants like benzodiazepines and barbiturates will react with alcohol, inducing both drowsiness and respiratory depression
• Mixing monoamine oxidase inhibitors such as Nardil with alcohol increases the risk of serotonin syndrome, symptoms caused by an excess of serotonin levels
• CYP3A4 enzyme inhibitors may lead patients to require lower doses of trazodone, and CYP3A4 inducers are likely to lead patients to require higher doses of trazodone
• Mixing alcohol with digoxin or phenytoin may increase serum levels in the medication, which may be toxic
• Mixing alcohol with NSAIDs (non-steroidal anti-inflammatory drugs) such as aspirin can increase the risk of bleeding

Do Not Mix Alcohol with Trazodone

Trazodone is a prescription drug designed to aid those with depressive disorders or anxiety disorders. It is clear that mixing alcohol with antidepressants will have adverse effects.

Mixing the two may also warrant medical attention, by affecting heart rhythms (irregular heartbeat) and blood pressure.

Depressive symptoms and symptoms of anxiety may reach dangerous levels due to the side effects of alcohol. Heavy drinking may affect treatment efficacy, and will likely exacerbate a depressive episode and anxiety attacks.

As tolerance increases, alcohol overdose and trazodone overdose are possible. This may lead to alcohol withdrawal syndrome, substance use disorder, and other medical conditions such as the risk of internal bleeding from different drug interactions.

Motor impairments and a lack of motor skills are likely when mixing drugs and alcohol. Interactions with trazodone mean that the effects of alcohol and medication are enhanced, causing sleepiness, drowsiness, and a lack of concentration.

Antidepressant medication such as trazodone may have their own medical risks. If you drink heavily at the same time or develop an alcohol addiction, the likelihood of a medical emergency is almost certain.

Medical professionals are here to help you recover from mental health illnesses, alcohol dependency, drug problems, and any type of addiction.

If you are suffering from feelings of depression, see a doctor as soon as you can. You will be advised to abstain from alcohol if you want to reduce health risks when taking medication for mental health.

References

[1] Shelton RC. Serotonin and norepinephrine reuptake inhibitors. Handb Exp Pharmacol. 2019;250:145-180. doi:10.1007/164_2018_164

[2] https://www.nhs.uk/medicines/trazodone/about-trazodone/

[3] Bowling Green State University. Effects of Alcohol.

[4] Lim RT, Jr, Gentry RT, Ito D, Yokoyama H, Baraona E, Lieber CS. First-pass metabolism of ethanol is predominantly gastric. Alcoholism: Clinical and Experimental Research. 1993;17:1337–1344.

[5] Martin NG, Perl J, Oakeshott JG, Gibson JB, Starmer GA, Wilks AV. A twin study of ethanol metabolism. Behavior Genetics. 1985;15:93–109.

[6] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6527027/#b8-245-255

[7] Bennion LJ, Li T-K. Alcohol metabolism in American Indians and whites: Lack of racial differences in metabolic rate and liver alcohol dehydrogenase. New England Journal of Medicine. 1976;294:9–13.

[8] Kopun M, Propping P. The kinetics of ethanol absorption and elimination in twins and supplementary repetitive experiments in singleton subjects. European Journal of Clinical Pharmacology. 1977;11:337–344

[9] Weathermon R, Crabb DW. Alcohol and medication interactions. Alcohol Res Health. 1999;23(1):40-54. PMID: 10890797; PMCID: PMC6761694.

[10] Caballeria J, Baraona E, Deulofeu R, Hernandez-Munoz R, Rodes J, Lieber CS. Effects of H-2 receptor antagonists on gastric alcohol dehydrogenase activity. Digestive Disease Sciences. 1991;36:1673–1679.

[11] Tinsley, J., Olsen, M., Laroche, R., and Palmen, M. (1994). Fluoxetine Abuse. Mayo Clinic Proceedings, 69(2), 166-168.

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