From the Guidelines
Long-term use of trazodone for sleep is not recommended due to its adverse effect profile, which outweighs its benefits, as evidenced by a 2020 systematic review published in the Annals of Internal Medicine 1. The potential adverse effects of taking trazodone for sleep long term include cognitive impairment, memory problems, and the development of tolerance. Trazodone can also cause orthostatic hypotension, which increases fall risk, particularly in older adults. Some patients may experience sexual dysfunction, including decreased libido or erectile problems. Rare but serious side effects include priapism, cardiac arrhythmias, and serotonin syndrome when combined with other serotonergic medications. Key points to consider when evaluating the risks of long-term trazodone use for sleep include:
- The lack of high-quality evidence supporting its efficacy for chronic insomnia disorder, with most studies having short durations of therapy and follow-up 1
- The potential for adverse events, such as falls and cognitive impairment in older patients, which can substantially outweigh the benefits of treatment 1
- The recommendation against using trazodone for treatment of chronic insomnia disorder, based on four fair-quality systematic reviews that evaluated the use of pharmacologic agents 1 It is essential to weigh these risks against the potential benefits of treatment and consider alternative therapies for managing chronic insomnia disorder. The work group advised against use of trazodone for treatment of chronic insomnia disorder, citing its adverse effect profile and the lack of high-quality evidence supporting its efficacy 1.
From the FDA Drug Label
Trazodone Hydrochloride Tablets can cause serious side effects or death, including: Serotonin syndrome. Symptoms of serotonin syndrome include: agitation, hallucinations, and problems with coordination, fast heartbeat, tight muscles, trouble walking, sweating, fever, nausea, vomiting, and diarrhea. Irregular or fast heartbeat or faint (QT prolongation) Low blood pressure You feel dizzy or faint when you change positions (go from sitting to standing) Unusual bruising or bleeding Erection lasting for more than 6 hours (priapism) Feeling high or in a very good mood, then becoming irritable, or having too much energy, feeling like you have to keep talking or do not sleep (mania). Withdrawal symptoms Symptoms of withdrawal can include anxiety, agitation, and sleep problems. The most common side effects of Trazodone Hydrochloride Tablets include: swelling blurred vision dizziness sleepiness tiredness diarrhea stuffy nose weight loss
The potential adverse effects of taking trazodone for sleep long term include:
- Serious side effects: serotonin syndrome, irregular or fast heartbeat, low blood pressure, unusual bruising or bleeding, priapism, mania, and withdrawal symptoms
- Common side effects: swelling, blurred vision, dizziness, sleepiness, tiredness, diarrhea, stuffy nose, and weight loss
- Other adverse reactions: visual problems, eye pain, changes in vision, swelling or redness in or around the eye, low sodium in the blood (hyponatremia) 2
- Cardiac disorders: cardio spasm, congestive heart failure, conduction block, orthostatic hypotension and syncope, palpitations, bradycardia, atrial fibrillation, myocardial infarction, cardiac arrest, arrhythmia, ventricular ectopic activity, including ventricular tachycardia and QT prolongation 2
From the Research
Potential Adverse Effects of Long-Term Trazodone Use for Sleep
- The most common adverse effect of trazodone is drowsiness, which is dose-dependent 3
- Trazodone use is associated with an increased risk of falls, particularly in older adults 4
- Other potential adverse effects of trazodone include:
- Trazodone may also have minor effects on sleep latency, efficiency, and daytime impairment 5
Considerations for Long-Term Use
- The efficacy and safety of trazodone for sleep disturbances have been demonstrated in several studies 6, 3, 7, 5
- However, the use of trazodone for sleep should be carefully evaluated, considering the potential risks and benefits 5
- Older adults, particularly those with dementia, may be at increased risk of adverse effects, such as falls 4
- Regular monitoring and assessment of trazodone use in long-term care settings is necessary to minimize potential adverse effects 4