Trazodone

July 22, 2018

About trazodone

Trazodone is an antidepressant medicine which works to balance chemicals in the brain.

It is used to treat depression, anxiety, or a combination of depression and anxiety. It can help if you're having problems like low mood, poor sleep and concentration.

Trazodone comes as tablets, capsules and liquid. It is only available on prescription.

Key facts

Doctors usually prescribe trazodone when other antidepressants haven't 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.
Trazodone can affect an unborn baby. Tell your doctor straight away if you're trying to get pregnant or become pregnant while taking it.
It can cause extra side effects if you stop taking it suddenly. Talk to your doctor before you stop taking it.
Trazodone is also called by the brand name Molipaxin.

Who can and can't 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 - trazodone can increase seizures
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 may change your blood sugar level. Check your blood sugar more often for the first few weeks of treatment with trazodone. Talk to your diabetes doctor if the reading goes too high or low.

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.

How much should I take?

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, don't 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?

It is important to stick to the dose on the label of the medicine but if you take more trazodone than this, contact your doctor for advice straight away.

An overdose can lead to potentially serious symptoms such as:

being sick (vomiting)
feeling very sleepy
being confused
feeling dizzy or fainting
problems with your heart or breathing
fits (seizures)

If you take too much trazodone by accident, contact your doctor for advice. If you've taken too much and experience any serious symptoms, go to the nearest hospital accident and emergency (A&E) department straight away.

If you need to go to hospital, take the trazodone packet or leaflet inside it plus any remaining medicine with you.

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 don't go away:

feeling sleepy or tired
headache
feeling sick
having constipation
a dry mouth

Serious side effects

If you experience any of these serious side effects, stop taking trazodone and speak to a doctor straight away:

a fast, slow or abnormal heartbeat
yellow skin, or the whites of your eyes turn yellow
thoughts of self-harming or ending your life
a fit (seizure)
a long lasting and painful erection which isn't to do with sexual activity
bad constipation or you're unable to pee and it's causing severe tummy 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 to trazodone.

A serious allergic reaction is an emergency. Contact a doctor straight away if you think you or someone around you is having a serious allergic reaction.

The warning signs of a serious allergic reaction are:

getting a skin rash that may include itchy, red, swollen, blistered or peeling skin
wheezing
tightness in the chest or throat
having trouble breathing or talking
swelling of the mouth, face, lips, tongue, or throat

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 to the UK safety scheme.

How to cope with side effects

Some of the common side effects of trazodone will gradually improve as your body gets used to it.

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, don't drive or use tools or machinery if you're feeling this way.
headache - make sure you rest and drink plenty of fluids. Don't 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.
having 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.

Pregnancy and breastfeeding

No antidepressants are considered completely safe to take in pregnancy or while breastfeeding, but your doctor may want to prescribe trazodone if the benefits to you outweigh the risks.

Taking trazodone in the late stages of pregnancy could make your baby have side effects when they are born. 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.

Talk to your doctor about taking trazodone if you are pregnant or planning to have a baby.

Breastfeeding and trazodone

Trazodone passes into breast milk and has been linked with side effects in breastfed babies. However, your doctor may still want to prescribe trazodone if the benefits to you outweigh the risks to your baby.

Tell your doctor if you're trying to get pregnant, are already pregnant or if you're breastfeeding.

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've taken any of these medicines within the last 2 weeks
antidepressants such as amitriptyline or fluoxetine
anti-fungal medicines such as ketoconazole and itraconazole
medicines for seizures such as carbamazepine or phenytoin
medicines for high blood pressure such as clonidine
sleeping pills, tranquilizers 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 are being treated with trazodone as this will increase your risk of side effects.

Tell your doctor or pharmacist if you are taking any other medicines, including herbal remedies, vitamins or supplements.

Common questions

How does trazodone work?

Serotonin and noradrenaline are chemicals in the brain which 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 will hopefully take in your stride little things that used to worry you.

Trazodone won't change your personality or make you feel euphorically happy. It will simply help you feel like yourself again.

When will I feel better?

Don't 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 is very important to speak to your doctor about it immediately. You can also contact the Samaritans.

If you're thinking about ending your life while taking trazodone go to your nearest hospital accident and emergency (A&E) department straight away.

How long will I take it for?

If you've only had one episode of depression, you will need to take trazodone for at least 6 months after you feel better. Stopping before that time can make depression come back.

If you've 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 don't 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 which keeps coming back. If you need it and don't get side effects, there's no reason to worry about taking trazodone for a long time.

Is trazodone addictive?

There is no evidence that trazodone is addictive. However, you may experience 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 will explain how to reduce your dose gradually.

How do I come off trazodone?

If you've been feeling better for 6 months or more, your doctor may suggest coming off trazodone. This should be done gradually to help prevent any extra side effects you might get as a reaction to coming off the medicine. Your doctor will explain how to do this.

If your symptoms return once you've stopped taking trazodone, ask your doctor for advice.

Don't stop taking trazodone suddenly, or without talking to your doctor.

How does trazodone compare with other antidepressants?

Trazodone isn't usually the first choice of antidepressant. Doctors usually prescribe it when other antidepressants haven't worked or have caused side effects.

It isn't 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've 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 aren't 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. Other potential treatments include:

talking therapy (such as cognitive behavioural therapy)
exercise programmes

Choosing a treatment that's most suitable for you depends on:

how long you've had depression
your symptoms
whether you've had depression 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). However, 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. However, it's sometimes used to treat some of 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 contraception?

Trazodone does not affect any type of contraception including contraceptive pills or the morning after pill.

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 very long lasting and painful erection which isn't to do with sexual activity. Contact your doctor straight away if this happens.

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?

Trazodone hasn't been properly tested with recreational drugs. Talk to your doctor if you think you might use recreational drugs while taking trazodone.

Recreational drugs may affect how you feel or how the trazodone works.