Approved indications: Oral trazodone hydrochloride is FDA-approved only for the treatment of major depressive disorder in adults, using immediate-release or extended-release formulations.

Common off-label uses (evidence level):

• Insomnia at low bedtime doses; supported by small clinical trials and extensive clinical use (moderate evidence), but not formally FDA-approved and sometimes limited by next-day sedation or dizziness.
• Anxiety disorders, post-traumatic stress disorder (PTSD), and agitation in dementia; based mainly on small studies and case reports (low to moderate quality evidence).
• Adjunctive treatment for chronic pain or fibromyalgia-associated sleep disturbance; supported by limited, low-quality evidence.

Efficacy expectations: For depression, sleep and anxiety symptoms may start to improve within 1–2 weeks, with fuller mood improvement typically taking 4–6 weeks or longer; for insomnia, sedation often occurs with the first dose. Overall antidepressant efficacy is roughly similar to many other antidepressants, but trazodone is often chosen when a sedating agent is desired at night or when other antidepressants cause intolerable side effects.

Typical adult dosing for depression:

• Immediate-release tablets: Common starting dose is 150 mg per day by mouth in divided doses, which may be increased by about 50 mg per day every 3–4 days as needed and tolerated; the usual maximum is 400 mg/day for outpatients (up to 600 mg/day in closely monitored inpatients).
• Extended-release tablets (where available): Often started at 150 mg once daily, usually at bedtime, with gradual increases (for example by 75 mg increments) as needed, up to a typical maximum of 375 mg/day.

How to take the medicine: Swallow tablets with water, usually after a meal or light snack to improve absorption and reduce stomach upset; the largest dose is often taken at bedtime because of sedation. Extended-release tablets should be swallowed whole without crushing, chewing, or splitting, unless the specific product labeling allows a scored tablet to be broken.

Special dosing instructions: Dose changes should be gradual to reduce side effects such as dizziness, low blood pressure, or withdrawal-like symptoms. When discontinuing trazodone after regular use, the dose is generally tapered down slowly rather than stopped abruptly.

Missed dose guidance: If a dose is missed, take it as soon as remembered unless it is close to the time of the next scheduled dose; if it is almost time for the next dose, skip the missed dose and resume the regular schedule, without doubling up.

Overdose: Taking too much trazodone can cause extreme drowsiness, vomiting, low blood pressure, fast or irregular heartbeat, seizures, or loss of consciousness; in any suspected overdose, call emergency services or a poison control center right away, and do not wait for symptoms to worsen.

Common side effects (usually mild to moderate):

• Drowsiness or sedation, dizziness, fatigue, headache, dry mouth, nausea, constipation, and blurred vision are very common, often beginning in the first days of treatment and sometimes improving as the body adjusts.
• Orthostatic hypotension (drop in blood pressure on standing), lightheadedness, and unsteadiness can occur, especially in older adults or when doses are increased.

Serious or rare adverse effects needing immediate medical attention:

• Priapism (a painful or prolonged erection lasting more than 4 hours) in males, which is a medical emergency.
• Signs of serotonin syndrome (such as agitation, confusion, fever, sweating, fast heart rate, muscle stiffness or twitching) especially when combined with other serotonin-affecting drugs.
• Irregular heartbeat, chest pain, fainting, or seizures, which may signal heart rhythm problems or other serious reactions.
• New or worsening depression, agitation, or suicidal thoughts, particularly in young adults, consistent with class warnings for antidepressants.
• Severe allergic reactions (rash, swelling of face or tongue, trouble breathing).

Warnings and precautions:

• Pregnancy: Use only if the potential benefit justifies the potential risk; data in pregnancy are limited, and newborns exposed late in pregnancy should be monitored for jitteriness, breathing or feeding difficulties.
• Breastfeeding: Trazodone passes into breast milk in small amounts; if used, infants should be observed for excessive sleepiness, poor feeding, or unusual behavior.
• Age considerations: Not approved for pediatric patients; in older adults, start at lower doses and increase slowly due to higher risks of falls, dizziness, and low blood pressure.
• Kidney or liver disease: Use with caution, often at lower doses and with closer monitoring, because the drug is metabolized in the liver and cleared by the body more slowly when these organs are impaired.

Comparative safety profile: Trazodone generally causes less sexual dysfunction and has lower risk of weight gain than many SSRIs, but it is more sedating and more likely to cause dizziness and low blood pressure; compared with older tricyclic antidepressants, it has fewer anticholinergic side effects but still carries risks of heart rhythm changes and overdose toxicity.

Reporting side effects and safety updates: Patients and caregivers can report suspected side effects directly to the FDA through the MedWatch program (online or by phone), and up-to-date safety information and drug safety communications are available on the FDA’s website.

Major drug and substance interactions:

• Other serotonergic drugs: Combining trazodone with SSRIs, SNRIs, MAOIs, triptans, tramadol, linezolid, methylene blue, or St. John’s wort increases the risk of serotonin syndrome; trazodone should not be used with MAOIs or within about 14 days of stopping an MAOI (and vice versa).
• CNS depressants and alcohol: Benzodiazepines, opioids, sedating antihistamines, sleep medicines, and alcohol can add to drowsiness, dizziness, breathing suppression, and impaired coordination; alcohol is best avoided.
• Drugs affecting heart rhythm: Certain antipsychotics, some antibiotics (such as specific macrolides and fluoroquinolones), and other QT-prolonging drugs may increase the risk of serious arrhythmias when combined with trazodone.
• CYP3A4 inhibitors and inducers: Strong inhibitors (for example some azole antifungals, protease inhibitors, and certain macrolide antibiotics) can raise trazodone levels and side effects, while inducers (such as carbamazepine, phenytoin, rifampin, and St. John’s wort) can lower its effectiveness.
• Blood pressure and erectile dysfunction drugs: Other blood pressure-lowering medicines, alpha-blockers, and phosphodiesterase-5 inhibitors (such as sildenafil) may enhance the risk of low blood pressure and fainting when used with trazodone.
• Anticoagulants and antiplatelets: Trazodone may affect bleeding risk when taken with drugs such as warfarin, aspirin, or other blood thinners, so closer monitoring (for example of INR with warfarin) may be needed.

Food, supplements, and procedures: Trazodone is typically taken with food or a light snack; alcohol and recreational sedatives should be avoided. Herbal products that affect serotonin (such as St. John’s wort) or increase bleeding risk (such as high-dose ginkgo) should be used cautiously or avoided. Use with intravenous methylene blue or certain contrast agents that have serotonergic properties requires special caution.

Precautions and conditions where use may be unsafe:

• History of heart disease, recent heart attack, or known prolonged QT interval.
• Uncontrolled glaucoma, seizure disorders, bipolar disorder, or a history of priapism.
• Moderate to severe liver or kidney impairment, where lower doses and close supervision are usually required.

Monitoring needs: Depending on individual risk factors, clinicians may monitor blood pressure (sitting and standing), heart rate, and symptoms of dizziness or fainting; consider an ECG in patients with cardiac disease or on other QT-prolonging medications; and periodically reassess mood, anxiety, sleep, and any suicidal thoughts or behavior, especially during the first weeks of treatment and after dose changes.

Q: Is trazodone mainly used for depression or for sleep?
A: Trazodone is officially approved to treat major depressive disorder, but at lower doses it is commonly prescribed off-label to help with insomnia or nighttime anxiety because of its sedating effects.

Q: How long does it take for trazodone to work?
A: Many people notice improved sleep or reduced nighttime anxiety within the first few doses, while full antidepressant effects for mood typically develop over several weeks, often around 4–6 weeks.

Q: Will trazodone make me gain weight?
A: Trazodone can cause changes in appetite and weight, but it is generally considered to have a lower risk of significant weight gain than many other antidepressants, though individual responses vary.

Q: Is trazodone addictive or a controlled substance?
A: Trazodone is not classified as a controlled substance and does not typically cause drug-seeking behavior, but it should still be taken only as prescribed and tapered gradually if used regularly.

Q: Can I drink alcohol while taking trazodone?
A: Alcohol should be avoided with trazodone because the combination can greatly increase drowsiness, dizziness, and risk of falls or accidents, and may worsen breathing problems or depress mood.

Q: Is it safe to take trazodone long term?
A: Many people use trazodone for months or longer under medical supervision, but ongoing treatment should be regularly reviewed to confirm that benefits continue to outweigh side effects and that no safer or more effective alternatives are appropriate.

Storage: Keep trazodone tablets at room temperature in a tightly closed container, away from moisture, heat, and direct light, and out of reach of children and pets.

Disposal: Do not flush trazodone down the toilet unless specifically instructed; when no take-back program is available, mix unused tablets with an undesirable substance (such as used coffee grounds or kitty litter), place in a sealed bag or container, and throw in the household trash, after removing or obscuring personal information on prescription labels.