Key takeaways
- Trazodone is FDA approved to treat major depressive disorder. It is not FDA approved for insomnia.
- Prescribing low-dose trazodone for sleep is common, and it is an off-label use.
- The American Academy of Sleep Medicine suggests that clinicians not use trazodone to treat insomnia, based on limited evidence.
- A licensed clinician who knows your health history decides whether any sleep medication is appropriate for you.
What is trazodone?
Trazodone is an antidepressant that also causes drowsiness, which is why some clinicians prescribe it at low doses for sleep.
Trazodone was approved by the FDA in 1981 to treat major depressive disorder [1]. It affects serotonin signaling and also blocks histamine and alpha-1 receptors. The histamine effect is the main reason it makes people sleepy.
Is trazodone approved for sleep?
No. Using trazodone for insomnia is off-label, which means a provider prescribes it for a use the FDA has not approved.
Off-label prescribing is legal and common, but it means the FDA has not reviewed evidence that the drug works for that use. Several medications are FDA approved for insomnia, including ramelteon, which acts on melatonin receptors [2].
What does the research show?
Evidence for trazodone in insomnia is limited and mostly short term.
A 2018 Cochrane review of antidepressants for insomnia found low-quality evidence that trazodone may modestly improve how people rate their sleep over short periods [3]. The 2017 American Academy of Sleep Medicine guideline weighed the same kind of evidence and suggested that clinicians not use trazodone for trouble falling or staying asleep [4]. That recommendation was rated weak, which means it is a judgment call for each patient.
| Medication | FDA approved for insomnia | How it works |
|---|---|---|
| Trazodone | No (off-label) | Serotonin and histamine effects |
| Ramelteon | Yes | Melatonin receptors |
What are the side effects?
The most common side effects are drowsiness, dizziness, dry mouth and headache.
Trazodone can lower blood pressure when you stand up, which can cause dizziness or falls. It can also cause next-day grogginess.
Important safety information. Trazodone carries a boxed warning about suicidal thoughts and behavior in children, teens and young adults [1]. It can affect heart rhythm, can cause serotonin syndrome when combined with other serotonergic drugs, and in rare cases causes priapism, an erection lasting more than 4 hours that needs emergency care. Do not combine it with alcohol or other sedatives unless your provider says it is safe.
Who should not take trazodone?
People with certain heart rhythm problems, people taking MAO inhibitors, and anyone who has had a reaction to trazodone should not take it.
Tell your provider about all medications and supplements, any history of heart problems, bipolar disorder or depression, and whether you are pregnant. Possible sleep apnea, such as loud snoring or gasping at night, needs a medical assessment before any sleep medication.
What should you do about trouble sleeping?
Start with sleep habits and talk with a clinician if the problem lasts.
Sleep habits come first: a regular schedule, limiting caffeine and alcohol, and treating conditions such as sleep apnea. If trouble sleeping lasts more than a few weeks, talk with your own clinician before you start any sleep medication. This article is for education only. Stackhaus Health does not offer sleep treatment.
What research supports
- Short-term, modest improvement in self-rated sleep quality in small trials [3].
- Sedation through histamine blockade at low doses [1].
What research does not show
- Long-term benefit or safety for insomnia.
- That it works better than FDA-approved insomnia medications.
- Strong, high-quality trial evidence [3][4].
Frequently asked questions
Is trazodone a sleeping pill?
No. It is an antidepressant. Some providers prescribe it off-label for sleep because it causes drowsiness.
Is trazodone habit-forming?
Trazodone is not a controlled substance, but the body can adjust to it over time, and stopping suddenly can cause withdrawal-type symptoms. Evidence for sleep covers short-term use only. Your provider decides how long to use it and how to stop.
Can I take trazodone with alcohol?
No. Alcohol adds to the sedation and dizziness.
How long does trazodone stay in your system?
Its half-life is several hours, and next-day drowsiness is possible. Your provider explains what to expect.
Can a telehealth provider prescribe trazodone?
A provider licensed in your state can prescribe it if they find it appropriate after reviewing your health history. Stackhaus Health does not offer sleep treatment.
References
- U.S. Food and Drug Administration. Trazodone hydrochloride tablets prescribing information. FDALabel. View label
- U.S. Food and Drug Administration. Rozerem (ramelteon) prescribing information. FDALabel. View label
- Everitt H, Baldwin DS, Stuart B, et al. Antidepressants for insomnia in adults. Cochrane Database of Systematic Reviews. 2018;5:CD010753. PubMed
- Sateia MJ, Buysse DJ, Krystal AD, et al. Clinical practice guideline for the pharmacologic treatment of chronic insomnia in adults: an American Academy of Sleep Medicine clinical practice guideline. Journal of Clinical Sleep Medicine. 2017;13(2):307-349. PubMed Central
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