Is it safe to drink alcohol while taking Trazodone?

Trazodone and Alcohol: A Dangerous Combination

It is not safe to drink alcohol while taking trazodone. The combination can cause dangerous additive effects on psychomotor performance and increase the risk of central nervous system depression. 1, 2

Risks of Combining Trazodone and Alcohol

Enhanced CNS Depression

• Trazodone is a sedating antidepressant that can cause drowsiness, dizziness, and impaired coordination on its own 2
• Alcohol is also a CNS depressant, and when combined with trazodone, these effects become significantly amplified 1
• The FDA drug label specifically warns against combining trazodone with alcohol due to the additive sedative effects 2

Specific Dangers

• Increased risk of excessive sedation and impaired coordination 2
• Significantly impaired driving ability and operation of machinery 2
• Potential for respiratory depression in higher doses 1
• Enhanced risk of falls, especially in elderly patients 1
• Possible orthostatic hypotension (dangerous drops in blood pressure when standing) 1
• Increased risk of paradoxical agitation in some individuals 1

Medication Interactions

Pharmacological Basis

• Trazodone acts as both a serotonin antagonist and reuptake inhibitor (SARI) 3
• Alcohol affects multiple neurotransmitter systems, including GABA and glutamate 4
• When combined, these substances have synergistic depressant effects on the central nervous system 1, 2

Warning from FDA Labeling

• The FDA explicitly states: "Do not drink alcohol or take other medicines that make you sleepy or dizzy while taking Trazodone Hydrochloride Tablets until you talk with your healthcare provider" 2
• The drug label further warns that "Trazodone Hydrochloride Tablets may make your sleepiness or dizziness worse if you take it with alcohol or other medicines that cause sleepiness or dizziness" 2

Special Considerations

Sleep Disorders

• While trazodone is commonly prescribed off-label for insomnia, combining it with alcohol can disrupt sleep architecture rather than improve it 1, 3
• Alcohol may initially help with falling asleep but typically causes fragmented, poor-quality sleep 5
• The combination may worsen rather than improve overall sleep quality 5

Recovery from Alcohol Dependence

• For patients in recovery from alcohol dependence, trazodone has shown mixed results 5
• One study found that while trazodone improved sleep quality during administration, it might impede improvements in alcohol consumption and lead to increased drinking when stopped 5
• Another study suggested potential benefits of trazodone in treating alcohol withdrawal symptoms, but this was a single case report and not a controlled trial 6

Clinical Recommendations

For Patients Taking Trazodone

• Completely avoid alcohol while taking trazodone 2
• Do not drive or operate dangerous machinery if you have consumed both substances 2
• If you have accidentally combined the two, seek medical attention if experiencing severe drowsiness, confusion, or difficulty breathing 2
• Never abruptly stop taking trazodone without medical supervision, as withdrawal symptoms can occur 2

For Healthcare Providers

• Clearly warn patients about the dangers of combining trazodone with alcohol 1, 2
• Consider alternative medications for patients with a history of alcohol use disorder 5
• Monitor for signs of alcohol use in patients prescribed trazodone, especially those with sleep disorders 3, 5
• Be aware that patients may underreport alcohol consumption 1

Conclusion

The evidence strongly indicates that combining trazodone and alcohol poses significant risks with no therapeutic benefit. The FDA drug label and multiple clinical guidelines explicitly warn against this combination due to the dangerous additive effects on the central nervous system.