trazodone trazodone trazodone, sold under many brand names, is an antidepressant medication. it is used to treat major depressive disorder, anxiety disorders, and difficulties with sleep. the medication is taken orally. trazodoneclinical datatrade namesdesyrel, trittico, othersother namesaf-1161ahfs/drugs.commonographmedlineplusa681038license data us dailymed: trazodone dependenceliabilitynoneaddictionliabilitynoneroutes ofadministrationby mouthatc coden06ax05 (who) legal statuslegal status au: s4 (prescription only) ca: ℞-only uk: pom (prescription only) us: ℞-only in general: ℞ (prescription only) pharmacokinetic databioavailabilityby mouth: 65%protein binding89–95%metabolismliver (cyp3a4, cyp2d6, cyp1a2?)metabolitesmcpponset of actionby mouth: 1 hour (tmax)elimination half-life• trazodone (ir): 4–15 hours• trazodone (er): 9–13 hours• mcpp: 3–16 hoursexcretionurine: 70–75%feces: 21%identifiers iupac name 2-triazolopyridin-3(2h)-one cas number19794-93-5 ypubchem cid5533iuphar/bps213drugbankdb00656 ychemspider5332 yuniiybk48bxk30keggd08626 yas hcl: d00820 ychebichebi:9654 ychemblchembl621 ycomptox dashboard (epa)dtxsid5045043 echa infocard100.039.364 chemical and physical dataformulac19h22cln5omolar mass371.87 g·mol−13d model (jsmol)interactive imagemelting point87 °c (189 °f) smiles clc4cccc(n3ccn(cccn1/n=c2/c=c\c=c/n2c1=o)cc3)c4 inchi inchi=1s/c19h22cln5o/c20-16-5-3-6-17(15-16)23-13-11-22(12-14-23)8-4-10-25-19(26)24-9-2-1-7-18(24)21-25/h1-3,5-7,9,15h,4,8,10-14h2 ykey:phlbkphsavxxef-uhfffaoysa-n y (verify) common side-effects include dry mouth, feeling faint, vomiting, and headache. more serious side effects may include suicide, mania, irregular heart rate, and pathologically prolonged erections. it is unclear if use during pregnancy or breastfeeding is safe. it is a phenylpiperazine compound of the serotonin antagonist and reuptake inhibitor (sari) class. trazodone also has sedating effects. trazodone was approved for medical use in the united states in 1981. it is available as a generic medication. in 2020, it was the 21st most commonly prescribed medication in the united states, with more than 26 million prescriptions. medical uses depression the primary use of trazodone is the treatment of unipolar major depression with or without anxiety. data from open and double-blind trials suggest the antidepressant efficacy of trazodone is comparable to that of amitriptyline, doxepin, and mianserin. also, trazodone showed anxiolytic properties, low cardiotoxicity, and relatively mild side effects. because trazodone has minimal anticholinergic activity, it was especially welcomed as a treatment for geriatric patients with depression when it first became available. three double-blind studies reported trazodone has antidepressant efficacy similar to that of other antidepressants in geriatric patients. however, a side effect of trazodone, orthostatic hypotension, which may cause dizziness and increase the risk of falling, can have devastating consequences for elderly patients; thus, this side effect, along with sedation, often makes trazodone less acceptable for this population, compared with newer compounds that share its lack of anticholinergic activity but not the rest of its side-effect profile. still, trazodone is often helpful for geriatric patients with depression who have severe agitation and insomnia. trazodone is usually used at a dosage of 150 to 300 mg/day for the treatment of depression. lower doses have also been used to augment other antidepressants, or when initiating therapy. higher doses up to 600 mg/day have been used in more severe cases of depression, for instance in hospitalized patients. trazodone is usually administered multiple times per day, but once-daily administration may be similarly effective. anxiety disorders trazodone is often used in the treatment of anxiety disorders such as generalized anxiety disorder, panic disorder, post-traumatic stress disorder (ptsd), and obsessive–compulsive disorder (ocd). however, use of trazodone in anxiety disorders is off-label and evidence of its effectiveness for these indications is variable and limited. benefits for ocd appear to be mild. besides anxiety, trazodone has been used to treat sleep disturbances and nightmares in ptsd. trazodone is often used as an alternative to benzodiazepines in the treatment of anxiety disorders. insomnia low-dose trazodone is used off-label in the treatment of insomnia and is considered to be effective and safe for this indication. it may also be used to treat antidepressant-related insomnia. trazodone was the second-most prescribed agent for insomnia in the early 2000s, though most studies of trazodone for treatment of sleep disturbances have been in depressed individuals. systematic reviews and meta-analyses published in the late 2010s, including a cochrane review, found low-dose trazodone to be an effective medication for short-term treatment of insomnia both in depressed and non-depressed people. trazodone slightly improves subjective sleep quality (smd = –0.34 to –0.41) and reduces number of nighttime awakenings (md = –0.31, smd = –0.51). conversely, it does not appear to affect sleep onset, total sleep time, time awake after sleep onset, or sleep efficiency. it appears to increase deep sleep, in contrast to certain other hypnotics. the quality of evidence of trazodone for short-term treatment of insomnia was rated as low to moderate. there is no evidence available at present to inform long-term use of trazodone in the treatment of insomnia. the benefits of trazodone for insomnia must be weighed against potential adverse effects such as morning grogginess, daytime sleepiness, cognitive and motor impairment, and postural hypotension, among others. quality safety data on use of trazodone as a sleep aid are currently lacking. trazodone is used at low doses in the range of 25 to 150 mg/day for insomnia. higher doses of 200 to 600 mg/day have also been studied. the american academy of sleep medicine's 2017 clinical practice guidelines recommended against the use of trazodone in the treatment of insomnia due to inadequate evidence and due to harms potentially outweighing benefits. combination with other antidepressants trazodone is often used in combination with other antidepressants such as selective serotonin reuptake inhibitors in order to augment their antidepressant and anxiolytic effects and to reduce side effects such as sexual dysfunction, anxiety, and insomnia. available forms trazodone is provided as the hydrochloride salt and is available in the form of 50 mg, 100 mg, 150 mg, and 300 mg oral tablets. an extended-release oral tablet formulation at doses of 150 mg and 300 mg is also available. side effects