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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by newo38 on July 5, 2009, at 22:39:42
it says there is a .01% chance of me getting a priapism, an erection that wont go away and can result in permanent impotence. Is .01% good or bad odds?
Posted by chumbawumba on July 5, 2009, at 22:46:23
In reply to I want to try Trazadone BUT, posted by newo38 on July 5, 2009, at 22:39:42
0.01 percent chance is one in ten thousand. It means there is a very, very small chance of getting an erection that won't go away.
Whether that is good or bad is up to you.
Posted by rjlockhart04-08 on July 5, 2009, at 23:09:41
In reply to I want to try Trazadone BUT, posted by newo38 on July 5, 2009, at 22:39:42
Trazodone keeps you glued to the bed, it's like putting glue in your mouth, and you stick to the bed.
Yuk!
Posted by Phillipa on July 5, 2009, at 23:18:49
In reply to Re: I want to try Trazadone BUT, posted by rjlockhart04-08 on July 5, 2009, at 23:09:41
Being female that's one problem don't have but I've heard it's very sedating. Phillipa
Posted by yxibow on July 6, 2009, at 7:03:49
In reply to I want to try Trazadone BUT, posted by newo38 on July 5, 2009, at 22:39:42
> it says there is a .01% chance of me getting a priapism, an erection that wont go away and can result in permanent impotence. Is .01% good or bad odds?
Its hard to really quantify the risks.
Its rare but not quite as rare as stated, but I don't know if I've heard of 1/10000 mentioned before, as statistics... well is statistics.
That being said I've had sub-clinical priapisms twice in college. Um... I stood on my head -- yes the one I'm thinking with now and problem solved.
But its not a laughing matter, that is true, for someone in their 60s or so who doesn't have quite the same rebound power as someone in their 20s.
Priapisms there, strong priapisms, have to be treated as hospital cases, and need prompt... yes... draining of blood.Impotence... that's another not quite quantifiable outcome but certainly less than priapisms properly and promptly dealt with.
Priapisms can occur naturally of course too and are warnings with things like Cialis / Viagra.
In conclusion I'd say -- if you haven't already tried or would interfere with other medicationsLunesta 3+mg
Remeron 7.5+mg
amitryptline 10mgthen its a medication worth trying. I'm just going on the "bleah" scale compared with the above. But some people swear by Trazodone, so who am I to say you might not too.
--- I'm assuming this is for sleep, because nefazodone is basically the only tolerable relative for antidepressant usefulness (trazodone would put one to sleep for the entire day at 400+ mg)-- Jay
Posted by linkadge on July 6, 2009, at 7:15:59
In reply to Re: I want to try Trazadone BUT » newo38, posted by yxibow on July 6, 2009, at 7:03:49
Probably unlikely that you will get a bad priapism if you start at lower doses and see how it affects you.
Even if you did get this effect, one can't assume that that:
a) it will be bad enough to warent medical intervention
b) with medical intervention you will be perminantly impotent
Posted by Nadezda on July 6, 2009, at 14:26:36
In reply to Re: I want to try Trazadone BUT, posted by linkadge on July 6, 2009, at 7:15:59
From what I could find, priapism would most likely occur at higher doses, not low doses; in the instances where low doses are involved, there's usually cocaine use, or use of other drugs that also cause priapism (which include cocaine); it would tend to occur in the earlier phase of, rather than after extended use; or when the dose is raised, again during the early period afterward.
I could find no statistics about resolution of priapism when it does occur, but the most serious outcome is less common than the symptom, which itself is rare. Obviously, .01% is 1/10,000-- which may sound bad-- but only somewhere around 200+ cases have occurred-- out of all the people taking trazodone-- . And to repeat, at a low dose, such as is used for sleep, it is even more rare.
You could try other sleep aids first-- but I think the likelihood of priapism at your dose is quite small-- smaller than .01%.
In the end, though, it's got to be your call. However, you can be vigilant about the symptom and take action immediately if it occurs-- which is also helpful.
Nadezda
Posted by bleauberry on July 6, 2009, at 16:00:07
In reply to I want to try Trazadone BUT, posted by newo38 on July 5, 2009, at 22:39:42
This is a bit off topic, but I can't imagine why anyone would want to try traz. In my book it is one of the few that is qualified to join the ranks of the most worthless meds ever invented. Seriously, most doctors gave up using it a long time ago. At best it may be a sleep aid in the 12.5mg-50mg range. Some people like it for that. Others find it a very depressing med the following day after sleeping on it.
If you are wanting to try it for depression or anxiety or augmentation, forget it. If it were a poker hand in Las Vegas, it would be one very likely to lose, and even if you won, the winnings would be pennies.
Not much to gain from that med. I would avoid it. There are far better choices no matter what the issue is you are trying to treat.
Posted by newo38 on July 6, 2009, at 16:26:10
In reply to Re: I want to try Trazadone BUT, posted by bleauberry on July 6, 2009, at 16:00:07
but it is a sedating AD that doesn;t cause sexual side-effects and that's what I need.
Posted by Phillipa on July 6, 2009, at 20:25:47
In reply to Yes, it seems like I shouldn;t, posted by newo38 on July 6, 2009, at 16:26:10
Pdoc I worked with took it for sleep and she was fine early in the am at the hospital. Give it a try. Lots of docs still use it from what mine has said. Phillipa
Posted by bleauberry on July 7, 2009, at 9:38:19
In reply to Yes, it seems like I shouldn;t, posted by newo38 on July 6, 2009, at 16:26:10
> but it is a sedating AD that doesn;t cause sexual side-effects and that's what I need.
Ok. Whatever. There are far better choices to accomplish those goals.
Sedating, yes, probably so much you won't care about sex. So in that respect, yes, it can have sexual side effects.
You'll get a whole lot more ummph for sleep, sex, and depression, with something like Nortriptyline or Amitriptyline.
Antidepresant? The real-world clinical evidence of traz being a dependable antidepressant is dismal. Experienced psychopharmacologists stopped using it many years ago. The only ones still using it are ones that don't know what they are doing or they are prescribing it as a sleep aid.
Posted by Tony P on July 10, 2009, at 21:37:34
In reply to Re: Yes, it seems like I shouldn;t, posted by bleauberry on July 7, 2009, at 9:38:19
> > but it is a sedating AD that doesn;t cause sexual side-effects and that's what I need.
>
> Ok. Whatever. There are far better choices to accomplish those goals.
>
> Sedating, yes, probably so much you won't care about sex. So in that respect, yes, it can have sexual side effects.
>
> You'll get a whole lot more ummph for sleep, sex, and depression, with something like Nortriptyline or Amitriptyline.
>
> Antidepresant? The real-world clinical evidence of traz being a dependable antidepressant is dismal. Experienced psychopharmacologists stopped using it many years ago. The only ones still using it are ones that don't know what they are doing or they are prescribing it as a sleep aid.
>
=================================
Recently went on traz again (been on it a couple of times before), 25-50 mg as needed for insomnia. My pdoc agreed with the above that it's a very poor A/D -- you need to get up around 600 mg/day, and I can't imagine staying awake on that! I find it the best combination of low side-effects and short half-life of all the non-hypnotic sleep aids I've tried.My pdoc said it's important how you take it and what kind of insomnia you have. Taking it 20 min. before bed & expecting to be out like a light will probably NOT work. Some people take it as much as a couple of hours before bedtime. According to him, its best effect is to stop you waking up in the small hours with a panic attack, which used to be a big part of my pattern & still is to some extent. I did have akathisia (like RLS all over) on it a few years ago but this time, touch wood, i'm fine.
I have a friend with the same problem as me -- waking up with my mind spinning its gears off -- and he's been on 50 mg for years without needing to up the dose.
Re the sex/priapism issue, I suspect (but have no citations) that the incidence of _serious_ priapism is very low indeed, or it would be off the market or at least black-labelled by now. For me, there is a slight benefit as I have ED, and am on an SNRI which makes me seriously anorgasmic. So (if I can stay awake) the very mild but definite effect it has on both conditions is very handy!
I did some brief research recently into the half-lives & side effects (both official and personal) of the half-dozen or so AD's & antihistamines I have tried for insomnia, and trazadone came out on top -- for me. Trimipramine gave me the most natural sleep, with Remeron a close runner up, but both have very long half-lives, 24 hr. or more, so I was sleeping for 36 hours at a stretch!
If anyone is interested, I will happily send them my spreadsheet or post a summary here (post a reply or babblemail me), on the understanding that this is a personal evaluation, e.g. I ignored side-effects that aren't a problem for me.
Tony P
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