Trazodone for Sleep: What to Know About This Antidepressant’s Common Off-Label Use
Key takeaways:
Trazodone is an antidepressant medication. It’s FDA approved to treat depression, but it’s more often taken off-label for sleep-related issues, like insomnia.
When taken 30 minutes before bedtime, a low dose of trazodone (between 25 mg and 100 mg) may be effective for promoting better sleep.
Trazodone is considered safe to take for short-term insomnia symptoms. There isn’t much safety data available about long-term use. It can also cause various side effects, such as drowsiness and headaches.
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When you don’t get a good night's rest, you notice the next day. Whether it’s difficulty falling asleep or staying asleep, sleep-related issues can have a big impact on your daily life.
If you’re having trouble sleeping and it’s turning into a consistent issue, know that you have options. There are several strategies and treatments — such as sleep hygiene tips, therapy, and medications — to help you sleep better.
Trazodone, an antidepressant medication, is occasionally used off-label as one of these treatments.
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What is trazodone used for?
Trazodone is a serotonin antagonist and reuptake inhibitor (SARI) medication, sometimes called an atypical antidepressant. It’s FDA approved to treat depression in adults, and it comes as tablets you can split in half. Trazodone is available as a generic medication with doses ranging from 50 mg to 300 mg. Its brand-name equivalent, Desyrel, is no longer available in the U.S.
Although trazodone is only officially approved to treat depression, it’s still prescribed for other conditions. Trazodone has many off-label uses, such as managing:
Anxiety, including sleep anxiety
Bulimia
Insomnia
Post-traumatic stress disorder (PTSD)
Substance use disorder
The most common off-label use for trazodone is treating sleep-related issues. Alongside its influence on serotonin, trazodone can act as a sedative — which means it can make you feel sleepy. Though it isn’t recommended as a first-choice medication by the American Academy of Sleep Medicine, it may have fewer risks than many other prescription sleeping pills.
Is it safe to take trazodone for sleep?
Yes, trazodone is generally safe for adults to take for sleep. But there isn’t much safety data in children, so trazodone isn't recommended for kids.
Even though trazodone isn’t officially approved for sleep, healthcare professionals have prescribed it as a sleep aid since the 1980s. And in the past, research has shown that trazodone may be a safe and effective treatment for insomnia at low doses.
But, like other medications, trazodone still has its risks. Your healthcare professional will need to consider many factors — such as your age, any other conditions that you have, and any other medications you’re taking — before prescribing you trazodone. It may not be safe for you to take trazodone if you have any of the following health conditions:
Bipolar disorder
Glaucoma
Heart disease
Kidney problems
Liver problems
Low blood pressure
Trazodone may also not be suitable for you if you are an older adult or are pregnant or breastfeeding.
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How much trazodone can I take for sleep?
There’s limited research on the best trazodone dosage for sleep. Studies show that a low dose of between 25 mg and 100 mg may be effective for sleep issues — which is a lower dose than when it’s used as an antidepressant. Even at these low doses, trazodone may be able to help you fall asleep and stay asleep.
If you’ve been diagnosed with depression and insomnia, the recommended maximum dosage is usually 400 mg per day. There isn’t a recommended maximum daily dose for insomnia alone. Your healthcare professional can help you decide the safest and most effective dose for you.
Be sure to follow up with your healthcare professional if you feel like trazodone isn’t working to help you sleep. They may adjust your dosage or consider switching you to another treatment.
How quickly does trazodone work for sleep?
Trazodone can start working within 30 minutes, but it may take up to 2 hours for some people to experience the effects. If trazodone doesn’t seem to work for you at all, speak with your prescriber or pharmacist.
Is it OK to take trazodone every night?
For most people, it’s OK to take trazodone every night for short-term sleeping issues (typically less than 1 month), but you should only take this medication as prescribed by your healthcare professional. There’s limited research on the safety of long-term trazodone for sleep. But there are some findings to keep in mind.
Compared to other sleep medications, such as benzodiazepines, trazodone has a low risk for dependence and misuse. Trazodone is not a controlled substance and doesn’t seem to be addictive.
But, as with all antidepressants, trazodone can cause withdrawal symptoms if you suddenly decrease your dosage or stop taking it. This is especially likely if you’ve been taking it every night for a long period of time.
If you’re planning to stop taking trazodone, talk to your healthcare professional. They may ask you to slowly decrease your dosage to avoid withdrawal symptoms. Symptoms of trazodone withdrawal can include agitation, anxiety, and increased sleeping issues.
What are the most common trazodone side effects?
Like all medications, trazodone can cause side effects. The most common trazodone side effects include:
Drowsiness
Dry mouth
Dizziness or lightheadedness
Headaches
Blurred vision
Nausea and vomiting
Trazodone also has a boxed warning — the FDA’s strongest medication warning — for a possible risk of suicidal thinking and behavior. This risk is highest in young adults who have just started treatment or are changing dosages. And in rare cases, trazodone can cause a serious health problem called priapism (an erection that lasts for more than 4 hours).
Contact your healthcare professional immediately if you start to experience changes in your thinking or any other side effects while taking trazodone.
Taking too much trazodone
Like with many medications, there’s a potential risk of experiencing an overdose with trazodone. This can occur if you take too much trazodone or if there’s a drug interaction with one of your other medications. In severe cases, this can be life-threatening.
Potential signs and symptoms of a trazodone overdose include:
Difficulty breathing
Drowsiness
Heart problems
Seizures
Vomiting
If you’re experiencing severe symptoms of a possible trazodone overdose, go to the nearest emergency room. If your symptoms feel more mild, it’s still a good idea to contact a healthcare professional and ask about next steps.
Frequently asked questions
Don't take trazodone within 14 days (2 weeks) of a monoamine oxidase inhibitor (MAOI), such as methylene blue, selegiline, or phenelzine (Nardil). The combination could lead to serotonin syndrome, a potentially serious health condition. Other serotonin-boosting medications — such as other antidepressants, opioid painkillers, and herbal supplements like St. John's wort — should be avoided for similar reasons. You should also do your best to avoid substances like alcohol and other sleeping pills to prevent excessive drowsiness. Other interactions are also possible.
One isn’t widely considered better than the other, but trazodone and melatonin work in different ways. Trazodone is an antidepressant, while melatonin is a hormone that regulates the sleep-wake cycle.
A small study that compared trazodone to melatonin in hospitalized people found no significant differences in effectiveness or side effects between the two. However, trazodone was more likely to interact with other medications.
Trazodone isn’t typically recommended for kids, teens, or those living with conditions like bipolar disorder. You also shouldn’t take it if you’re experiencing any thoughts of suicide or self-harm. If you have a history of liver or kidney issues, heart disease, or seizures, trazodone should be used with caution.
The bottom line
Trazodone is an antidepressant that is commonly taken off-label to treat sleep problems. The typical trazodone dosage for sleep is 25 mg to 100 mg before bedtime. Trazodone is generally considered safe to use short-term for sleep issues. But you should contact your healthcare professional if you experience any bothersome side effects or don’t feel like trazodone is working for you.
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References
Jaffer, K. Y., et al. (2017). Trazodone for insomnia: A systematic review. Innovations in Clinical Neuroscience.
Kale, P., et al. (2015). Pharmacokinetics of single oral dose trazodone: A randomized, two-period, cross-over trial in healthy, adult, human volunteers under fed condition. Frontiers in Pharmacology.
Letsinger, E., et al. (2022). Melatonin versus trazodone for the treatment of new onset insomnia in hospitalized adult patients. Hospital Pharmacy.
MedlinePlus. (2022). Trazodone.
National Center for Complementary and Integrative Health. (2024). Melatonin: What you need to know.
National Health Service. (2022). Common questions about trazodone.
Sateia, M. J., et al. (2017). Clinical practice guideline for the pharmacologic treatment of chronic insomnia in adults: An American Academy of Sleep Medicine clinical practice guide. Journal of Clinical Sleep Medicine.
Shin, J. J., et al. (2024). Trazodone. StatPearls.
NuCare Pharmaceuticals. (2024). Trazodone hydrochloride - trazodone hydrochloride tablet [package insert]. DailyMed.
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