Trazodone — What it Treats and How to Use It Safely

Trazodone is an older antidepressant that many doctors also prescribe for sleep problems. It can help with low mood and with falling or staying asleep. Because it makes most people drowsy, patients often notice faster sleep improvement than mood changes. That sleep effect is why many people ask about it first.

How people use trazodone

For insomnia, doctors usually start with a low dose at bedtime — often 25–100 mg. For depression, doses are higher and usually split through the day, commonly 150–300 mg total, sometimes up to 400 mg under close supervision. Never change dose or schedule without checking with your prescriber.

It’s taken by mouth. Some people take it with food to avoid an upset stomach, but because it causes sleepiness, take it when you can stay in bed for several hours. Expect drowsiness the first few nights; that often improves after a week or two.

Safety tips and interactions

Common side effects include drowsiness, dizziness when standing up too fast (orthostatic hypotension), dry mouth, and blurred vision. A rare but serious side effect is priapism — a prolonged painful erection. If that happens, get emergency care right away.

Mixing trazodone with alcohol or other sedatives increases drowsiness and breathing problems. It can also interact with several medications: other antidepressants, triptans for migraines, MAO inhibitors, some antifungals and antibiotics that affect liver enzymes. These interactions can raise the risk of serotonin syndrome, which causes agitation, rapid heart rate, high body temperature, and coordination problems. If you take multiple drugs that affect serotonin, tell your prescriber immediately.

Trazodone is processed in the liver (CYP3A4 pathway). Strong enzyme inhibitors like ketoconazole or clarithromycin can raise trazodone levels; inducers like rifampin can lower them. Your doctor should review all your medicines — prescription, over-the-counter, and herbal — before starting trazodone.

Don’t drive, operate heavy machinery, or sign important papers until you know how trazodone affects you. Older adults are more prone to falls and low blood pressure from trazodone, so doctors often use lower doses in seniors.

If you’re pregnant, breastfeeding, or have heart disease, talk to your doctor about risks and alternatives. Stopping trazodone suddenly can cause withdrawal symptoms such as dizziness, anxiety, or sleep disturbance; follow a taper plan if you stop taking it.

Questions to ask your prescriber: Why trazodone for me? What dose should I start with? How long before I see benefits? What side effects should trigger a call? With clear answers, you’ll feel safer and more confident using trazodone if it’s the right choice for you.