Overview
Active ingredient: trazodone.
Therapeutic category: Antidepressant, specifically a serotonin antagonist and reuptake inhibitor (SARI).
FDA status in the USA: Approved for major depressive disorder. Clinicians may also prescribe off label for conditions such as insomnia, anxiety symptoms, or certain chronic pain syndromes when appropriate.
Available strengths noted here: 100 mg tablets. Other strengths may also exist depending on the manufacturer.
Intended use: Trazodone is primarily used to treat depression. Some clinicians use it to help with sleep initiation or maintenance and to alleviate anxiety or tension. Your prescriber decides the best use for your situation. For how to take it, see How To Take It.
How To Take Trazodone
Always follow the dosing plan set by your prescriber and the instructions on your prescription label. Trazodone is commonly taken shortly after a meal or a light snack to improve tolerability.
You should receive a Medication Guide with each fill. Read it carefully the first time and again whenever your prescription is renewed. If questions come up, speak with your pharmacist or prescriber.
It can take 1 to 4 weeks to notice mood benefits. Do not stop trazodone suddenly unless advised by your clinician, as symptoms may return or withdrawal effects may occur. For missed doses, see Missed Dose. For proper storage, see Storage.
How It Works
Trazodone is a SARI: it blocks certain serotonin receptors and inhibits serotonin reuptake. This dual action is thought to enhance serotonin signaling, which can elevate mood. Its antihistamine and alpha-1 adrenergic blocking properties may also produce sedation and lightheadedness, which is why many people feel sleepy after a dose taken at night.
Missed Dose
If you miss a dose you take regularly, take it when you remember unless it is close to the time for your next scheduled dose. If it is almost time for the next dose, skip the missed dose and resume your normal schedule. Do not take two doses at once.
Storage
Store at 68 to 77 degrees F (20 to 25 degrees C). Brief excursions between 59 and 86 degrees F (15 to 30 degrees C) are acceptable. Keep the bottle tightly closed, away from heat, moisture, and direct light. Do not store in a bathroom. Keep out of reach of children and pets.
Warnings and Precautions
Do not use trazodone if any of the following apply:
- You are currently taking sodium oxybate (GHB).
- You have had an allergic reaction to trazodone or nefazodone in the past.
- You are using, or have recently used, a monoamine oxidase inhibitor (MAOI) within the last 14 days, or you intend to start an MAOI within 14 days of stopping trazodone.
Before using, tell your clinician if you have or have had:
- Any heart condition, including arrhythmias or a recent heart attack.
- Glaucoma (especially narrow-angle) or trouble urinating due to prostate enlargement.
- Seizures, epilepsy, or a history of head injury.
- Suicidal thoughts, prior suicide attempts, bipolar disorder, or a history of depression that rapidly cycles.
- Liver or kidney disease.
- Regular alcohol use or substance use disorder.
- Upcoming surgery or procedures requiring anesthesia.
- Pregnancy, plans to become pregnant, or breastfeeding.
- Use of herbal products or supplements such as St. Johns wort or ginkgo.
Boxed warning: Antidepressants, including trazodone, may increase the risk of suicidal thinking and behavior in children, adolescents, and young adults, particularly early in treatment or after dose changes. Monitor closely and contact a clinician if mood worsens or suicidal thoughts emerge.
Avoid alcohol until you know how trazodone affects you. Do not drive or operate heavy machinery until you understand your response, as sedation and dizziness are common.
Drug and Supplement Interactions
Tell your prescriber and pharmacist about all medicines and supplements you take. Important interactions include:
- MAO inhibitors (isocarboxazid, linezolid, methylene blue, phenelzine, selegiline, tranylcypromine) - contraindicated due to risk of severe reactions.
- Strong CYP3A4 inhibitors such as ketoconazole, itraconazole, and some HIV protease inhibitors like ritonavir - may increase trazodone levels.
- Carbamazepine or other enzyme inducers - may reduce trazodone levels and effectiveness.
- Warfarin and other anticoagulants - monitor closely; effects may change and bleeding risk may increase.
- Serotonergic drugs (SSRIs such as fluoxetine or sertraline; SNRIs; triptans; linezolid; St. Johns wort; buspirone) - risk of serotonin syndrome may rise.
- Phenytoin and other hydantoins - potential changes in levels; monitor.
- Phenothiazines such as thioridazine - additive side effects like drowsiness or heart rhythm changes.
- Digoxin - possible alterations in levels; monitor as directed.
- Ethanol and other CNS depressants - increased sedation and impaired coordination.
- Sodium oxybate (GHB) - do not combine due to profound CNS depression risk.
This is not a complete list. Keep an updated medication list and share it at each visit.
Possible Side Effects
Common, usually mild, and often improve with time:
- Drowsiness or feeling sedated.
- Dry mouth or stuffy nose.
- Headache, dizziness, or lightheadedness, especially when standing.
- Nausea, stomach discomfort, constipation, or decreased appetite.
- Blurred vision, tremor, nervousness, or problems with coordination.
- Fatigue, muscle aches or general body discomfort, and swelling of the skin.
- Trouble sleeping or vivid dreams.
Serious - seek urgent medical help:
- Allergic reaction: rash, hives, itching, swelling of the face, lips, tongue, or throat; trouble breathing.
- Priapism: prolonged, painful, or inappropriate erections. This is a medical emergency.
- Irregular heartbeat, fainting, chest pain, or shortness of breath.
- New or worsening depression, agitation, unusual behavior changes, or suicidal thoughts.
- Seizures or stroke-like symptoms.
- Severe dizziness when standing, or vomiting with inability to keep fluids down.
- Blood in urine or signs of internal bleeding.
Report troublesome or persistent effects to your healthcare professional.
Alternatives and Similar Medicines
Depending on your diagnosis and symptoms, clinicians might consider:
- SSRIs such as sertraline, fluoxetine, escitalopram - commonly first line options for depression and many anxiety disorders.
- SNRIs such as venlafaxine or duloxetine - may help when pain or certain anxiety symptoms are prominent.
- Bupropion - less likely to cause sexual side effects or sedation; may be activating.
- Mirtazapine - helpful when appetite loss or insomnia are major issues; tends to be sedating at lower doses.
- Doxepin (low dose) or hydroxyzine - sometimes used for sleep or anxiety, respectively.
- For insomnia specifically, noncontrolled options such as doxepin 3 to 6 mg, ramelteon, or melatonin may be considered; controlled hypnotics such as zolpidem or eszopiclone are alternatives but have stricter rules and risks.
Medication choice depends on side effect profile, coexisting conditions, prior response, and drug interactions. Discuss with your prescriber which option best matches your goals.
See price comparisons for several common alternatives.
Typical Retail Prices in the USA
Approximate cash prices for 30 tablets (generic, common strengths) without insurance. Actual costs vary by pharmacy, region, dosage, and discounts:
- Trazodone 100 mg: about USD 5 to 25.
- Sertraline 50 mg: about USD 4 to 15.
- Mirtazapine 15 mg: about USD 6 to 18.
- Bupropion SR 150 mg: about USD 8 to 25.
- Duloxetine 30 mg: about USD 8 to 40.
- Doxepin 10 mg: about USD 9 to 30.
- Zolpidem 10 mg: about USD 8 to 35 (Schedule IV controlled; pricing and access differ).
Generics are usually much less expensive than brand names. Insurance copays, manufacturer coupons, and discount cards may reduce out-of-pocket costs.
Legal and Regulatory Information in the USA
- Status: Trazodone is prescription-only but not a controlled substance under the federal Controlled Substances Act.
- Indication: FDA-approved for major depressive disorder. Off-label use (for example, insomnia) is legal at the prescribers discretion when medically appropriate.
- Boxed warning: All antidepressants carry a suicidality warning for children, adolescents, and young adults.
- Prescribing: In-person and telemedicine prescribing are permitted when clinicians comply with state and federal rules. E-prescribing is widely used.
- Refills: Number of refills must be authorized by the prescriber. Since trazodone is not controlled, federal limits are less strict than for controlled hypnotics.
- Driving and work safety: Until you know how trazodone affects you, do not drive, cycle, or operate machinery.
- Online pharmacies: Federal law generally requires a valid prescription from a licensed U.S. prescriber. Importing prescription medicines for personal use from abroad is generally illegal, with narrow exceptions; quality and safety risks are significant. Use verified U.S. pharmacies.
- Pediatrics: Not approved for pediatric depression; use, if any, requires specialist oversight and careful monitoring.
- Disposal: Use take-back programs or follow FDA guidelines for safe disposal if take-back is not available.
State rules can differ. When in doubt, consult your pharmacist or state board of pharmacy.
More Information
If you have questions about trazodone, speak with your doctor, pharmacist, or another qualified healthcare provider. Use only the medication prescribed to you and do not share it with others. For guidance on side effects, see Possible Side Effects. For safe keeping, review Storage. If you take other medicines or supplements, always review potential interactions.
