*An off-label use of a medication is a use that is not FDA-approved. Prescribers can decide to use a medication off-label because, in their professional judgment, they believe it may offer a benefit to someone.
Trazodone is used to treat depression, anxiety, and sleeping problems. Trazodone starts working in 1-2 weeks after the start of treatment. Some side effects of trazodone include dizziness, drowsiness, and diarrhea. Trazodone carries a serious warning of increased risk of suicidal thoughts and behaviors in children and young adults.1
If you’re considering trazodone, online psychiatry platforms such as Talkiatry and Brightside Health can connect you with a provider quickly. They offer assessments and can provide a prescription if they determine trazodone or another medication may help your symptoms.
Boxed Warning: Trazodone – Risk of suicidal thoughts and behaviors
Trazodone has a has a black box warning. These are the most serious types of warnings from the Food and Drug Administration (FDA). Trazodone can increase the risk of suicidal thoughts and behaviors in children, adolescents, and young adults. Regardless of your age, you should talk with your doctor about serious risks with trazodone and any other medications before starting treatment.
What Is Trazodone?
Trazodone is an antidepressant indicated for the treatment of major depressive disorder (MDD). The way trazodone works to treat depression is not completely understood. Trazodone is known to affect serotonin levels in the central nervous system (CNS). As a selective serotonin reuptake inhibitor (SSRI), it blocks the reabsorption (reuptake) of serotonin, a chemical in your brain, leaving more free serotonin available in the brain, leading to a better mood.1
Trazodone is FDA-approved to treat MDD in adults. An FDA approval means that the medication has gone through in-depth research demonstrating its safety and effectiveness for the approved indication of MDD.1
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Is Trazodone a Strong Sleeping Pill?
Trazodone is not FDA-approved for insomnia or as a sleeping pill. However, trazodone may help with sleep due to its sedating propertie, especially for those who also have depression. At low doses, trazodone can make it easier for patients to fall and stay asleep. Though not an FDA-approved use, trazodone is generally considered safe for the short-term treatment of insomnia.2
Is Trazodone the Same as Xanax?
Trazodone and Xanax are not the same medication. Trazodone is an antidepressant medication that is used to treat major depressive disorder. Trazodone may also be used to treat anxiety disorders and difficulties with sleep. Xanax is a benzodiazepine medication that is primarily used to treat anxiety and panic disorders.
While both trazodone and Xanax can treat anxiety, trazodone is not habit-forming like Xanax. Xanax carries more risks like addiction, severe withdrawal, and increased danger for older patients. Additionally, trazodone is considered safer for elderly patients, while Xanax is not recommended for use in elderly patients.1, 3
How Does Trazodone Work?
Trazodone works to treat major depression by increasing the amount of serotonin, a natural substance in the brain that helps maintain mental balance and improve mood. When serotonin is low, it can lead to depression symptoms like sadness, loss of interest, low energy, poor appetite, and trouble sleeping. Increasing serotonin levels with trazodone helps improve mood, appetite, and energy levels, as well as decrease anxiety and insomnia related to depression.1, 4
What Is Trazodone Used to Treat?
Trazodone is FDA-approved to treat major depressive disorder (MDD). FDA approval means that the drug has undergone a review process, and the FDA has determined that its benefits outweigh its known and potential risks for the intended patient population.1
Trazodone is commonly prescribed for “off-label” uses. Off-label means the medication is being used in a way not approved by the FDA. However, providers can legally prescribe it when it is in the best interest of the patient. Some common off-label uses of trazodone include anxiety disorders, insomnia, and post-traumatic stress disorder (PTSD).4
Common Side Effects of Trazodone
Trazodone can cause side effects, but most are mild and tend to improve with continued use. The most common include drowsiness, dizziness, and swelling. Blurred vision, fatigue, diarrhea, and weight gain from trazodone may also occur. While trazodone is generally well-tolerated, contact your doctor or pharmacist if any effects are severe, don’t go away, or interfere with your daily activities. They can evaluate whether an adjustment is needed.1
Common side effects of trazodone include:1
- Swelling
- Blurred vision
- Dizziness
- Sleepiness
- Tiredness
- Diarrhea
- Weight changes
*All medications, including trazodone, can cause side effects which can be mild or serious. This is not a comprehensive list of all possible side effects. You should talk with your doctor or pharmacist about any questions you have and to understand the potential side effects and benefits of any medication.
Serious Side Effects of Trazodone
While rare, trazodone can cause some serious side effects that need medical care right away. These may affect areas like the heart, muscles, mood, or other senses. Signs of allergic reactions like rash, itching, swelling, and trouble breathing also require immediate attention. Make sure to contact your doctor or pharmacist promptly or get emergency help if you experience any concerning or severe symptoms while taking trazodone.1
Serious side effects of trazodone include:*1
- Serotonin syndrome
- Irregular or fast heartbeat or fainting
- Low blood pressure
- Unusual bruising or bleeding:
- Withdrawal symptoms
- Visual problems
*All medications, including trazodone, can cause side effects which can be mild or serious. This is not a comprehensive list of all possible side effects. You should talk with your doctor or pharmacist about any questions you have and to understand the potential side effects and benefits of any medication.
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*Includes copayment, deductible, coinsurance, and $0 Visits. Excludes no shows. **On average. Actual appointment times vary by state and individual patient.
Trazodone Warnings & Precautions
Before beginning your trazodone treatment, it’s important to have an open discussion with your healthcare provider about some crucial precautions and warnings associated with this medication. First, it’s vital to be aware that trazodone can potentially increase thoughts of self-harm and behavior in children, teenagers, and young adults. Therefore, close monitoring of your mental well-being is essential while taking trazodone.
Second, trazodone can impact your heart rhythm, particularly if you have pre-existing heart conditions. It’s important to disclose any heart issues to your doctor or pharmacist to ensure your safety during treatment. Third, trazodone can interact with several other medications that also influence serotonin levels. Combining trazodone with these drugs can elevate the risk of serotonin syndrome, a severe and life-threatening condition.
Other precautions to keep in mind encompass the potential for bleeding, the rare but serious possibility of priapism (erection longer than 4 hours), and the risk of glaucoma (increased eye pressure). If you have bipolar disorder, trazodone may exacerbate your symptoms, and abruptly stopping the medication can lead to withdrawal symptoms. It is crucial to communicate openly with your doctor and pharmacist about any concerns or side effects you may experience while taking trazodone, as they can provide you with the necessary guidance and medical attention to address these issues promptly.1
Avoid taking trazodone if you:1
- Are diagnosed with bipolar disorder: Taking trazodone in patients with bipolar disorder may activate mania/hypomania.
- Have a history of heart arrhythmias: Trazodone may change heart rhythms in patients with pre-existing heart disease.
- Are currently on blood pressure medications: Trazodone can cause low blood pressure.
- Have a history of anatomically narrow angles: Taking trazodone may trigger glaucoma (increased eye pressure) in patients
- Are diagnosed with sickle cell anemia, multiple myeloma or leukemia: Men who have conditions that might predispose them to priapism (erection longer than 4 hours), should take trazodone with caution and seek immediate medical attention for any signs of this side effect.
Trazodone Dosages for FDA-Approved Treatment
Trazodone dosing is individualized based on each person’s needs, medical condition, age, and responses. For adults, the typical starting dosage for depression is 150 mg per day, which can be slowly increased by your prescriber.
The maximum dosage for patients is typically 400 mg per day. For the treatment of insomnia, an off-label dose, the dosage typically ranges from 25 mg to 100 mg before bedtime. In elderly patients, the dosage should be reduced, typically starting at 100 mg per day. It is also important to note that trazodone should be taken after meals to decrease the chance of lightheadedness and low blood pressure.1, 2
In pediatric patients, the dosage of trazodone is typically calculated based on the child’s weight. However, it is important to note that trazodone is not normally recommended for children under 18 years of age unless a prescriber determines that it is the best medication to treat the child’s condition.5
Trazodone Forms & Strengths
Trazodone is available as an immediate-release tablet and comes in multiple strengths. The prescriber will choose an appropriate strength depending on several factors. These include the patient’s age, the condition being treated, the patient’s overall health status, and the patient’s response to the medication. This form of trazodone is rapidly absorbed, with the highest levels in the body occurring 1 to 2 hours after oral doses.1
Trazodone is available in the following forms and strengths:
- 50 milligram (mg) oral tablet
- 100 milligram (mg) oral tablet
- 150 milligram (mg) oral tablet
- 300 milligram (mg) oral tablet
How Quickly Does Trazodone Take Effect?
Trazodone typically starts to take effect within 1 to 2 hours. However, the full therapeutic effects of trazodone, particularly for conditions like depression, may not be felt immediately. It can take several weeks of consistent use for trazodone to reach its maximum effectiveness in managing depression and other related conditions.
When trazodone starts to take effect, individuals may experience a sense of calm and relaxation due to its sedative (inducing sleep) properties. It is important to note that the onset of these effects can vary from person to person, and some people may start to feel the effects of trazodone sooner than others.1, 4, 6
How Should I Take Trazodone?
Trazodone should be taken shortly after a meal or light snack. Swallow the trazodone tablet whole or break it in half along the score line following prescriber and pharmacist instructions. Do not chew or crush trazodone tablets and take trazodone with water. The timing of doses depends on what trazodone is being used for. Take trazodone tablets exactly as your healthcare provider tells you.1
What Happens If I Miss a Dose of Trazodone?
If you miss a dose of trazodone, take it as soon as you remember. However, if it is almost time for your next dose, you should skip the missed dose and continue with your regular dosing schedule. It is important not to double up on doses to make up for a missed dose.1
Can You Overdose on Trazodone?
Yes, you can overdose on trazodone. Trazodone overdose can lead to severe and life-threatening consequences. The risk of overdose is significantly higher when trazodone is taken in combination with alcohol, sedatives, or other central nervous system depressants (e.g. Xanax, Valium). Symptoms of trazodone overdose may include low blood pressure, heart rhythm disturbances, seizures, airway failure, and painful, prolonged erections lasting more than 4 hours (priapism). Other indicators of overdose include extreme drowsiness, vomiting, and confusion.1
What Should You Do If You Take Too Much Trazodone?
If you suspect you have taken too much trazodone, it is crucial to seek immediate medical attention. In cases of overdose, the symptoms can be severe and potentially life-threatening. If you suspect an overdose, immediately call 911 or Poison Control at 1-800-222-1222.1
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What to Avoid When Taking Trazodone
When taking trazodone, it’s vital to avoid certain interactions and substances. Do not use trazodone if you are currently on or have taken a monoamine oxidase inhibitor (MAOI, e,g, phenylzine, selegiline) within the past two weeks, and consult your healthcare provider if you are unsure about your medication’s compatibility with trazodone.
Additionally, inform your healthcare provider of any other medications you are taking, including triptans (for migraine), tramadol, St. John’s Wort, NSAIDs, aspirin, warfarin, phenytoin, diuretics, or drugs for mood, anxiety, psychotic, or thought disorders, as combining these with trazodone can lead to serious side effects due to potential interactions.
While using trazodone, exercise caution when engaging in activities requiring mental alertness, such as driving or operating heavy machinery, as it may slow your thinking and motor skills. Furthermore, avoid alcohol and other medications that cause drowsiness or dizziness, as their combination with trazodone can intensify these effects, potentially compromising your safety. Always consult your healthcare provider to ensure the safe and effective use of trazodone and to address any concerns or potential interactions.1
9 substances you should avoid while taking trazodone include:1
- Monoamine Oxidase Inhibitor (MAOI, e.g. selegiline): Avoid taking an MAOI with trazodone. Do not take an MAOI within two weeks of stopping trazodone unless directed to do so by your healthcare provider.
- Alcohol: Drinking alcohol while taking trazodone can make your sleepiness or dizziness worse.
- Triptans (e.g. Imitrex or sumatriptan): Using triptans along with trazodone may result in an increased risk of serotonin syndrome.
- Tramadol: Combining tramadol and trazodone can lead to increased sedation and dizziness.
- St. John’s Wort: The use of St. John’s wort with trazodone can increase the risk of side effects.
- Nonsteroidal Anti-Inflammatory Drugs (NSAIDs, e.g. Aleve) and aspirin: These medications may interact with trazodone, potentially increasing the risk of bruising or bleeding.
- Warfarin: When taken with trazodone, warfarin’s effects on blood clotting may be affected.
- Phenytoin: Taking phenytoin and trazodone can lead to increased levels of phenytoin in the body.
- Diuretics (e.g. furosemide): Combining diuretics and trazodone may result in additive effects in lowering your blood pressure. If you aren’t sure if other medications you take fall into any of these categories, check with your doctor or pharmacist.
Trazodone Antidepressant Discontinuation
Stopping trazodone abruptly can cause antidepressant discontinuation syndrome. To avoid trazodone withdrawal symptoms, it is important to taper off trazodone slowly under a doctor’s supervision. Gradually decreasing the dosage over a period of weeks or months allows your body to adjust and minimizes the risk of discontinuation symptoms. Abrupt cessation should be avoided whenever possible.1
How to Get a Prescription for Trazodone
Trazodone is a prescription-only medication, which means that it can only be obtained with a prescription from a licensed healthcare provider. This medication is typically prescribed by psychiatrists, primary care physicians, and other healthcare providers who specialize in mental health. To obtain a prescription for trazodone, you will need to undergo a medical evaluation to determine whether it is an appropriate and helpful treatment for your condition. This evaluation may include a physical exam, a review of your medical history, and a discussion of your symptoms.1
How Much Does Trazodone Cost?
The cost of trazodone can vary depending on several factors, including the strength of the medication, the pharmacy you use, and whether you use a brand-name or generic version of the drug. Without insurance, a 30-day supply of trazodone 50 mg can typically cost approximately $20 out of pocket. There are coupons and discount cards available and patient assistance programs available for patients as well.7
Questions to Ask Your Healthcare Provider About Trazodone
If you are considering taking trazodone, it’s important to discuss your options with your doctor, psychiatrist, therapist, or pharmacist. Additionally, you can ask your doctor or pharmacist about the potential benefits and risks of taking trazodone, as well as any alternative treatments that may be available. If you need to change prescribers or do not have access to in-person healthcare services, online psychiatry services may be a good option. These services allow you to connect with licensed healthcare providers remotely, often through video conferencing or messaging platforms.
Questions to ask your care team about trazodone include:
- How safe is trazodone?
- How long will it take for me to adjust to taking trazodone?
- How long will trazodone last in my system?
- How long does trazodone take to work?
- How does trazodone work to treat my condition?
- Am I at risk for more serious symptoms with tradozone if I am already taking other medications?
- What is the best dosage of trazodone to ensure fewer side effects?
- How often should I see my healthcare provider while taking trazodone?
- Are there any lifestyle changes I should make while taking trazodone?
- What should I do if I experience side effects with trazodone?
- Is it safe to drive after taking trazodone?
In My Experience
In my experience, trazodone can be an effective medication when used appropriately under medical supervision. While results vary for each individual, trazodone offers hope to many people struggling with depression, anxiety, insomnia, and other conditions. Trazodone does come with potential side effects and risks. That is why it is very important to have an open conversation with your doctor before starting treatment.
I recommend sharing all health history, medications, and concerns to determine if trazodone is suitable for your situation. Following your prescriber’s instructions for taking trazodone can help optimize benefits and minimize side effects. Reporting any issues promptly in case an adjustment is needed. While trazodone is not right for everyone, understanding its proper use, risks, and alternatives enables making an informed choice.
Additional Resources
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