Trazodone: what it treats, how to take it, side effects
Last updated September 3, 2026.
Trazodone is a serotonin modulator used to treat depression, and widely prescribed for sleep. It increases serotonin in the brain. It makes many people drowsy, which is exactly why lower doses are so often given at bedtime - and why the first-dose rules matter.
What does it treat?
Its approved use is depression. MedlinePlus also lists the off-label uses doctors reach for: insomnia, schizophrenia, anxiety, abnormal movements caused by other medications, and alcohol dependence. Whether the sleep use fits you is a decision for your prescriber - it is common, but it is a judgment call, not a label indication.
How do you take it?
With a meal or a light snack, two or more times a day at the same times, swallowing the tablet whole or split on its score line. The label's starting dose is 150 mg per day in divided doses, raised by no more than 50 mg per day every 3 to 4 days, with a usual outpatient maximum of 400 mg per day. Prescribers using it for sleep typically work at much lower bedtime doses - follow your own label, not someone else's. Full antidepressant benefit can take 2 weeks or longer. Do not stop suddenly; withdrawal can bring dizziness, nausea, headache, confusion, anxiety, sleep problems, and tingling in the hands or feet, so exits taper. If you miss a dose, take it when you remember unless the next one is close; never double up.
Side effects to know
- Common: diarrhea, changes in appetite or weight, weakness or tiredness, sexual problems, stuffy nose, and swelling of the hands, feet, or legs. Dizziness when standing up is common enough that MedlinePlus gives it a routine: get out of bed slowly, feet on the floor for a few minutes before standing.
- Serious: an erection lasting more than 6 hours (priapism - a genuine emergency); chest pain, shortness of breath, dizziness, or fainting; a fast, pounding, or irregular heartbeat; seizures; unusual bruising or bleeding; serotonin syndrome (fever, sweating, confusion, severe muscle stiffness, agitation, hallucinations, loss of coordination); and low sodium (headache, unsteadiness, trouble thinking or remembering).
Who should not take it?
MAO inhibitors are off-limits - within the past 2 weeks before starting, and for at least 14 days after stopping trazodone. Tell your doctor if you or a family member has long QT syndrome, or if you have had a heart attack; the label also advises against use during the initial recovery phase of a heart attack. Flag bleeding problems, sickle cell anemia, multiple myeloma, leukemia, and conditions affecting the shape of the penis, since these raise the priapism and bleeding stakes. Interactions include St. John's wort, tryptophan, aspirin, and NSAIDs like ibuprofen and naproxen. Ask about grapefruit and grapefruit juice. If you are pregnant, planning pregnancy, or breastfeeding, call your doctor. Alcohol makes its side effects worse, and it can impair judgment and coordination - no driving until you know its effects.
When is it an emergency?
An erection lasting more than 6 hours is an emergency - go to the emergency room, because waiting can cause permanent damage. Fainting, chest pain, and a pounding or irregular heartbeat also warrant emergency care, as do seizures and serotonin syndrome. For an overdose, call Poison Control at 1-800-222-1222. Pymander's escalation routing is built and tested specifically for this class of decision; see the safety architecture working paper.
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Common questions
Is trazodone a sleeping pill?
Not officially - it is an antidepressant (a serotonin modulator) whose approved use is depression. MedlinePlus lists insomnia among its other, off-label uses, and in practice many clinicians prescribe low bedtime doses for sleep. That decision, and the dose, belong to your prescriber.
How long does trazodone take to work?
Two timelines. For depression, MedlinePlus says 2 weeks or longer before full benefit. For sleep, the drowsiness effect is felt the same night you take it. Either way, do not stop suddenly - withdrawal can bring dizziness, nausea, headache, confusion, anxiety, and sleep problems.
Why do I feel dizzy when I stand up on trazodone?
Trazodone can cause a drop in blood pressure when you get up too fast. MedlinePlus's fix is mechanical: get out of bed slowly, rest your feet on the floor for a few minutes before standing. Fainting, not just wooziness, goes on the call-your-doctor-immediately list.
What is the erection warning about?
Trazodone can rarely cause priapism - an erection lasting more than 6 hours. MedlinePlus puts it on the immediate-attention list because it can cause permanent damage if not treated. It is rare, but it is the one trazodone side effect with no wait-and-see option.
Can I drink alcohol with trazodone?
Ask your doctor. MedlinePlus says alcohol can make trazodone's side effects worse - and the drowsiness and dizziness are exactly the effects that get amplified. Many prescribers recommend skipping alcohol entirely while on it.
Can I take trazodone with ibuprofen or aspirin?
Not without checking. MedlinePlus flags aspirin and NSAIDs like ibuprofen and naproxen (bleeding risk) plus St. John's wort and tryptophan (serotonin risk) as interactions. Give your pharmacist the full list of what you take before adding anything.