From the Guidelines
Trazodone should not be used as a first-line treatment for insomnia due to its adverse effect profile and the availability of safer alternatives. The work group advised against the use of trazodone for treatment of chronic insomnia disorder, based on 4 fair-quality systematic reviews 1 that evaluated the use of pharmacologic agents. Although trazodone was more effective at improving subjective sleep quality, there were no differences in sleep onset latency, total sleep time, or wake after sleep onset compared to placebo 1. The low-quality evidence supporting the efficacy of trazodone was outweighed by its adverse effect profile.
Some key points to consider when evaluating the use of trazodone for insomnia include:
- The potential for adverse effects, such as dizziness, dry mouth, and morning drowsiness
- The risk of priapism in men, although rare
- The potential for interactions with other serotonergic medications
- The availability of safer alternatives, such as nonbenzodiazepine BZRAs, which have been shown to be effective in improving sleep efficiency and reducing the risk of adverse events 1
Overall, while trazodone may be effective in improving subjective sleep quality, its adverse effect profile and the availability of safer alternatives make it a less desirable option for the treatment of insomnia. The work group's recommendation against the use of trazodone for chronic insomnia disorder should be taken into consideration when making treatment decisions.
From the Research
Trazodone for Insomnia
- Trazodone is one of the most commonly used prescription medications for insomnia, despite some clinical guidelines not recommending its use for this purpose 2.
- The evidence for the efficacy of trazodone in treating insomnia is limited, with most studies being small and conducted in populations of depressed patients 3.
- A systematic review of 45 studies found that trazodone has been repeatedly demonstrated to be effective for primary and secondary insomnia, with side effects being dose-dependent and the most common being drowsiness 4.
- Trazodone has been shown to be effective in the treatment of insomnia, with a good tolerability profile and a low number of adverse reactions 5.
- Trazodone has also been used as a hypnotic for psychotropic-induced or other insomnias with some success, although further clinical experience is needed to confirm these preliminary results 6.
Efficacy and Safety
- The efficacy of trazodone for insomnia has been demonstrated in several studies, although the evidence is not conclusive 2, 3, 4.
- The safety of trazodone for insomnia has been evaluated, with side effects being generally mild and dose-dependent 4, 5, 6.
- The risk/benefit ratio of trazodone for insomnia is uncertain, particularly in non-depressed patients, due to the limited evidence and potential adverse events 3.
Clinical Use
- Trazodone may be considered for the treatment of insomnia, particularly in patients with depression or anxiety, due to its sedative and anxiolytic properties 2, 4, 6.
- The use of trazodone for insomnia should be carefully evaluated, taking into account the individual patient's needs and medical history, as well as the potential risks and benefits 3, 5, 6.