Trazodone for Sleep: Dosage, Benefits, Side Effects & Other Risks

Trazodone is a prescription medication approved for use by the Food and Drug Administration (FDA) as an antidepressant.

This medicine works in multiple ways in your body. One of its actions is to regulate the neurotransmitter serotonin, which helps brain cells communicate with each other and influences many activities such as sleep, thoughts, mood, appetite, and behavior.

Even at lower doses, trazodone can cause you to feel relaxed, tired, and sleepy. It does this by blocking chemicals in the brain that interact with serotonin and other neurotransmitters, such as, 5-HT2A, alpha1 adrenergic receptors, and H1 histamine receptors.

This effect may be one of the main reasons trazodone works as a sleep aid.

FDA Warning about trazodone

Like many antidepressants, trazodone has been issued a 'Black Box Warning' by the FDA.

Taking trazodone has increased the risk of suicidal thoughts and behaviors in pediatric and young adult patients. People taking this medication should be closely monitored for worsening symptoms and emergence of suicidal thoughts and behaviors. Trazodone is not approved for use in pediatric patients.

Though the FDA has approved trazodone for use as a treatment for depression in adults, for many years doctors have also prescribed it as a sleep aid.

The FDA approves medications to treat specific conditions based on clinical trials. When doctors prescribe the medicine for conditions other than what was approved by the FDA, it is known as off-label prescribing.

Off-label use of a medication is a widespread practice. Twenty percent of medications are prescribed off-label. Physicians can prescribe medications off-label based on their experience and judgment.

Trazodone is most often prescribed at doses between 25mg to 100mg as a sleep aid.

However, studies show lower dosages of trazodone are effective and may cause less daytime sleepiness and fewer side effects because the drug is short acting.

Experts recommend cognitive behavioral therapy and other behavioral modifications as the first treatment for insomnia and sleep problems.

If these treatment options are not effective for you, your doctor may prescribe trazodone for sleep. Your doctor may also prescribe it if other sleep medications, such as Xanax, Valium, Ativan, and others (short- to medium-acting benzodiazepine medications), haven't worked for you.

A few advantages of trazodone include:

• Effective treatment for insomnia. A 2017 review of studies of trazodone use for insomnia found the medication was effective for primary and secondary insomnia in low doses.
• Reduced cost. Trazodone is less expensive than some newer insomnia medicines because it is available generically.
• Not addictive. Compared to other medications, such as the benzodiazepine class of medications like Valium and Xanax, trazodone is not addictive.
• May help prevent age-related mental decline. Trazodone might help improve slow wave sleep. This may slow certain types of age-related mental decline like memory in older adults.
• May be a better choice if you have sleep apnea. Some sleep medications may negatively affect obstructive sleep apnea and sleep arousal. A small 2014 study found that 100mg of trazodone had a positive impact on sleep arousal.

Trazodone may cause some side effects, especially when first starting the medication.

This is not a complete list of side effects. Discuss concerns with your doctor or pharmacist if you feel you are experiencing side effects or have other worries about your medicine.

Some common side effects of trazodone include:

• sleepiness
• dizziness
• fatigue
• nervousness
• dry mouth
• weight changes (in approximately 5 percent of people taking it)

Although rare, trazodone can cause serious reactions. Call 911 or local emergency services if you are experiencing any life-threatening symptoms such as difficulty breathing.

According to the FDA, serious risks include:

• Thoughts of suicide. This risk is higher in young adults and children.
• Serotonin syndrome. This occurs when too much serotonin builds up in the body and may lead to serious reactions. The risk of serotonin syndrome is higher when taking other medications or supplements that raise serotonin levels such as some migraine medications. Symptoms include:
  • hallucinations, agitation, dizziness, seizures
  • increased heart rate, body temperature, headaches
  • muscle tremor, rigidity, trouble with balance
  • nausea, vomiting, diarrhea
• Cardiac arrhythmias. The risk of changes in heart rhythm is higher if you already have heart problems.
• Priapism. This is a risk of an erection lasting a long time which is painful.
• Hypotension. This sudden drop in blood pressure may occur more often when you stand up from sitting.
• Increased risk of bleeding. Taking medications that interfere with blood clotting like blood thinner such as Warfarin, Heparin, or Plavix increase this risk.
• Mania. Individuals may experience euphoria, hyperactivity, or excessive excitement.
• Blurred vision.
• Hyponatremia. Sodium imbalance in the blood may occur. Symptoms include:
  • headache
  • confusion
  • weakness
  • unsteadiness
  • seizures
• Discontinuation syndrome. Trazodone, unlike benzodiazepines, is not addictive. However, because your body can become used to trazodone, it is important to talk with your doctor about the best way to slowly stop the medicine. Suddenly stopping trazodone may cause withdrawal symptoms.

Trazodone overdose

There have been reports of overdose with trazodone use. These risks are higher with drinking alcohol, taking benzodiazepines, and other central nervous system depressant drugs that can slow your breathing and reactions.

Drug overdose can be fatal. If you suspect you have taken too much trazodone, call 911 or local emergency services and seek medical attention immediately.

symptoms of overdose

Symptoms of trazodone overdose include:

• drowsiness
• seizures
• vomiting
• heart rhythm changes
• respiratory arrest (stop breathing)

Trazodone is an older medication approved for use by the FDA in 1981 as an antidepressant. Although trazodone use for sleep is common, according to recent guidelines published by the American Academy of Sleep Medicine, trazodone should not be the first line of treatment for insomnia.

Given in lower doses, it may cause less daytime sleepiness or drowsiness. Trazodone is not addictive, and common side effects are dry mouth, drowsiness, dizziness, and lightheadedness.

Trazodone may offer benefits in certain conditions such as sleep apnea over other sleep aids.