1. About trazodone
Trazodone is an antidepressant medicine that works to balance chemicals in the brain.
It can help if you're having problems like low mood, poor sleep and poor concentration.
Trazodone comes as tablets, capsules and liquid. It's only available on prescription.
2. Key facts
- Doctors usually prescribe trazodone when other antidepressants have not worked or have caused side effects.
- It can take 1 to 2 weeks before trazodone starts to work, but may be 4 to 6 weeks before you feel the full benefit.
- Trazodone can make you feel sleepy. If you take it once a day, it's best to take it in the evening or before you go to bed.
- If you and your doctor decide to take you off trazodone, your doctor will probably recommend reducing your dose gradually to help prevent extra side effects.
- Trazodone is also called by the brand name Molipaxin.
3. Who can and cannot take trazodone
Trazodone can be taken by adults over 18 years of age for depression or anxiety, or both.
Check with your doctor before starting to take trazodone if you:
- have had an allergic reaction to trazodone or any other medicines in the past
- have had thoughts of self-harming or ending your life
- have recently had a heart attack or have heart, kidney or liver problems
- are taking sleeping tablets
- have epilepsy or are having electroconvulsive treatment – trazodone may increase your risk of having a seizure
- are pregnant, trying to become pregnant or breastfeeding
- have the rare diseases porphyria (a blood disorder) or phaeochromocytoma (which affects the adrenal glands)
If you have diabetes, trazodone can make it more difficult to keep your blood sugar stable.
Monitor your blood sugar more often for the first few weeks of treatment with trazodone and adjust your diabetes treatment if necessary.
Speak to your doctor if your blood sugar levels are causing you concern.
4. How and when to take it
Your doctor may advise you to take your dose of trazodone once a day.
If your dose is 300mg a day or less, your doctor will probably tell you to take it as a single dose at bedtime.
As trazodone can make you feel sleepy, taking it at bedtime may help if you're having trouble sleeping.
If you have a larger dose, your doctor may suggest that you split it and take it twice a day.
You should take trazodone after food to reduce the chances of feeling sick.
For depression, the usual dose is 150mg daily. But in some cases your doctor may start you on a lower dose of 100mg to reduce the chance of side effects.
For anxiety, the usual dose is 75mg daily.
Will my dose go up or down?
Your dose may go up or down depending on how it affects you. Your doctor may prescribe up to 300mg a day for anxiety, or more for depression, if you need a stronger dose.
What if I forget to take it?
If you forget to take a dose, do not worry. Take it as soon as you remember, unless it's almost time for your next dose. In this case, skip the missed dose and take your next dose as normal.
Never take a double dose to make up for a forgotten one.
If you often forget doses, it may help to set an alarm to remind you.
You could also ask your pharmacist for advice on other ways to help you remember to take your medicines.
What if I take too much?
The amount of trazodone that leads to an overdose varies from person to person.
Urgent advice: Call your doctor straight away if:
You take too much trazodone and have symptoms including:
- being sick
- feeling very sleepy
- being confused
- feeling dizzy or fainting
- problems with your heart or breathing
- having a fit or seizure
If you need to go to A&E, do not drive yourself – get someone else to drive you or call for an ambulance.
Take the trazodone packet or leaflet inside it, plus any remaining medicine, with you.
5. Side effects
Like all medicines, trazodone can cause side effects in some people, but many people have no side effects or only minor ones.
Some of the common side effects of trazodone will gradually improve as your body gets used to it.
Common side effects
Tell your doctor if these side effects bother you or do not go away:
- feeling sleepy or tired
- feeling sick
- constipation (difficulty pooing)
- a dry mouth
Serious side effects
Serious side effects are rare and happen in less than 1 in 1,000 people.
Go to A&E immediately if you have:
- a long-lasting and painful erection that lasts longer than 4 hours – this may happen even when you're not having sex
- a fast, slow or abnormal heartbeat
- a seizure
Speak to your doctor straight away if you get:
- yellow skin, or the whites of your eyes turn yellow
- thoughts of self-harming or ending your life
- bad constipation or you're unable to pee and it's causing severe stomach pain
- more bruising than usual
- more infections than usual, such as a sore throat or skin infections
Serious allergic reaction
In rare cases, it's possible to have a serious allergic reaction (anaphylaxis) to trazodone.
Immediate action required: Call 999 or go to A&E now if:
- you get a skin rash that may include itchy, red, swollen, blistered or peeling skin
- you're wheezing
- you get tightness in the chest or throat
- you have trouble breathing or talking
- your mouth, face, lips, tongue or throat start swelling
You could be having a serious allergic reaction and may need immediate treatment in hospital.
These are not all the side effects of trazodone. For a full list, see the leaflet inside your medicines packet.
You can report any suspected side effect using the Yellow Card safety scheme.
6. How to cope with side effects
What to do about:
- feeling sleepy or tired – take trazodone in the evening and cut down the amount of alcohol you drink. If you take trazodone twice a day, talk to your doctor. Feeling sleepy should become less of a problem after a few days as your body gets used to the medicine. In the meantime, do not drive or use tools or machinery if you're feeling this way.
- headaches – make sure you rest and drink plenty of fluids. Do not drink too much alcohol. Talk to your doctor if the headaches last longer than a week or are severe.
- feeling sick – try taking trazodone with or after food to see if that helps. It's best to avoid rich or spicy food while you're taking this medicine.
- constipation – eat more high-fibre foods, such as fresh fruit and vegetables and cereals. Try to drink several glasses of water or another non-alcoholic liquid every day. If you can, it may also help to do some exercise. Watch a short video on how to treat constipation.
- a dry mouth – chew sugar-free gum or sugar-free sweets.
7. Pregnancy and breastfeeding
It's important for you and your baby that you stay well during your pregnancy.
If you become pregnant while taking trazodone, speak to your doctor. Do not stop taking your medicine unless your doctor tells you to.
Trazodone has been linked to a very small increased risk of problems for your unborn baby.
But if your depression is not treated during pregnancy, this can also increase the chance of problems.
You may need to take trazodone during pregnancy if you need it to remain well.
Your doctor can explain the risks and the benefits, and will help you decide which treatment is best for you and your baby.
For more information about how trazodone can affect you and your baby during pregnancy, read this leaflet on the Best Use of Medicines in Pregnancy (BUMPS) website.
Trazodone and breastfeeding
If your doctor or health visitor says your baby is healthy, trazodone can be used during breastfeeding.
Trazodone passes into breast milk in very small amounts, and has not been linked with any side effects.
It's important to continue taking trazodone to keep you well. Breastfeeding will also benefit both you and your baby.
If you notice that your baby is not feeding as well as usual, seems unusually sleepy, or you have any other concerns about your baby, talk to your health visitor or doctor as soon as possible.
Non-urgent advice: Tell your doctor if you're:
- trying to get pregnant
8. Cautions with other medicines
Many medicines and trazodone can interfere with each other and increase the chances of you having side effects.
Tell your doctor if you're taking these medicines before you start trazodone:
- tranylcypromine, phenelzine and isocarboxazid (for depression), or selegiline (for Parkinson's disease) – tell your doctor if you have taken any of these medicines within the last 2 weeks
- antidepressants, such as amitriptyline or fluoxetine
- antifungal medicines, such as ketoconazole and itraconazole
- medicines for seizures, such as carbamazepine or phenytoin
- medicines for high blood pressure, such as clonidine
- sleeping pills, tranquilisers or other sedatives
- digoxin, a heart medicine
- erythromycin, an antibiotic
- levodopa, used to treat Parkinson's disease
- ritonavir, used to treat HIV infections
- warfarin, a blood thinner
Mixing trazodone with herbal remedies and supplements
Do not take St John's wort, the herbal remedy for depression, while you're being treated with trazodone as this will increase your risk of side effects.
Important: Medicine safety
Tell your doctor or pharmacist if you're taking any other medicines, including herbal medicines, vitamins or supplements.
9. Common questions
How does trazodone work?
Serotonin and noradrenaline are chemicals in the brain that help improve your mood. When your levels are low, you can get depressed.
Trazodone helps increase your levels of serotonin and noradrenaline so you feel better.
How will it make me feel?
In the first few days trazodone may make you feel sleepy.
Antidepressants like trazodone help to jump start your mood so you feel better.
You may notice that you sleep better and get on with people more easily because you're less anxious.
You'll hopefully take in your stride little things that used to worry you.
Trazodone will not change your personality or make you feel euphorically happy. It will simply help you feel like yourself again.
When will I feel better?
Do not expect to feel better overnight. Trazodone can take 1 to 2 weeks to start to work, and it can be 4 to 6 weeks before you feel the full benefit. Give the medicine at least 6 weeks to work.
Some people feel worse during the first few weeks of treatment before they begin to feel better.
In this time some people occasionally have thoughts of harming themselves or ending their lives.
If this happens to you, it's very important to speak to a doctor about it immediately.
If you need additional help, you can also contact the Samaritans.
How long will I take it for?
If you have only had 1 episode of depression, you'll need to take trazodone for at least 6 months after you feel better.
Stopping before that time can make depression come back.
If you have had depression more than once, your doctor may recommend carrying on with trazodone for much longer.
Is it safe to take it for a long time?
Yes, trazodone is safe to take for a long time. There do not seem to be any lasting harmful effects from taking it for many months, or even years.
Some people need to take trazodone long term to treat depression or anxiety that keeps coming back.
If you need it and do not get side effects, there's no reason to worry about taking trazodone for a long time.
Is trazodone addictive?
There's no evidence that trazodone is addictive. But you may get extra side effects if you stop taking it suddenly.
This can cause sleep problems. It can also leave you feeling irritable and you may sweat more than usual.
To prevent any extra side effects, talk to your doctor about the best way to come off trazodone.
They'll explain how to reduce your dose gradually.
How do I come off trazodone?
If you have been feeling better for 6 months or more, your doctor may suggest coming off trazodone.
Your doctor will probably recommend reducing your dose gradually over several weeks, or longer if you have been taking trazodone for a long time.
This is to help prevent any extra side effects you might get as a reaction to coming off the medicine.
- feeling sick
- numbness or tingling in the hands or feet
- trouble sleeping
- feeling agitated or anxious
Do not stop taking trazodone suddenly, or without talking to your doctor.
How does trazodone compare with other antidepressants?
Trazodone is not usually the first choice of antidepressant.
Doctors usually prescribe it when other antidepressants have not worked or have caused side effects.
It is not any better or worse than other antidepressants. Some people respond better to one antidepressant than another.
Your doctor will recommend an antidepressant for you based on any other health issues you may have and the medicines you have tried already.
You may find trazodone helpful if you have anxiety and problems getting to sleep, or if you're irritable and agitated.
Trazodone is not as suitable for elderly people, who may get more side effects.
If you are not feeling any better after 6 weeks, talk to your doctor.
Are there other treatments that will help?
Antidepressants, including trazodone, are just one of several approaches to treating depression or anxiety.
Other potential treatments for depression include:
- talking therapy (such as cognitive behavioural therapy)
- exercise programmes
Other potential treatments for anxiety include:
- talking therapy (such as cognitive behavioural therapy)
- joining a self-help group
- using relaxation techniques
Choosing a treatment that's most suitable for you depends on:
- how long you have had depression or anxiety
- your symptoms
- whether you have had depression or anxiety before
- whether previous treatment worked
- how likely you are to stick with your treatment
- the potential side effects
- your preferences and priorities
If you're interested in any of these treatments, talk to your doctor.
Will my doctor prescribe trazodone to help me sleep?
Trazodone may make you sleepy. Because of this, it may be a suitable medicine if you have anxiety and difficulty sleeping (insomnia).
But your doctor will not prescribe it just to help you sleep. It has not been officially approved for this.
Can trazodone protect me against dementia?
At the moment, there's no evidence that trazodone protects against dementia.
But it's sometimes used to treat some symptoms of dementia, like irritability and agitation.
There are steps you can take that may reduce your risk of dementia.
If you're worried about getting dementia or Alzheimer's disease, or have a family history of these conditions, speak to your doctor.
Will I gain or lose weight?
Trazodone can make you feel more or less hungry than usual, so you may lose or gain weight when you start taking it.
If you start to have problems with your weight while taking trazodone, talk to your doctor or pharmacist.
Will it affect my fertility?
There's no clear evidence to suggest that taking trazodone will reduce fertility in either men or women.
But speak to a pharmacist or doctor if you're trying to get pregnant. They may want to review your treatment.
Will it affect my sex life?
Trazodone can cause problems with ejaculation. Some people say it gives them a higher sex drive, others say it makes it lower.
Rarely, men may get a painful erection that lasts a long time that is not to do with sexual activity.
If you have a long-lasting and painful erection that lasts longer than 4 hours, go to A&E straight away.
Can I drive or ride a bike?
Trazodone may make you feel sleepy or less alert. Do not drive, cycle, or use tools or machinery until you know how this medicine affects you.
Can I drink alcohol with it?
You can drink alcohol while taking trazodone, but it may make you feel sleepy.
It might be best to stop drinking alcohol until you see how the medicine makes you feel.
Is there any food or drink I need to avoid?
You can eat and drink normally while taking trazodone.
Will recreational drugs affect it?
Cannabis with trazodone can give you a fast heartbeat. Cannabis can also make drowsiness worse with citalopram, especially in people who have just started taking it.
Methadone can increase the risk of side effects in people taking sertraline.
It can be potentially dangerous to take trazodone with:
- stimulants like MDMA (ecstasy) or cocaine
- hallucinogens like LSD
- novel psychoactive substances (which used to be known as legal highs) like mephedrone
Trazodone has not been properly tested with recreational drugs.
Talk to your doctor if you think you might use recreational drugs while taking trazodone.