From the Guidelines
I strongly advise against taking trazodone for sleep while on oxycodone without medical supervision due to potentially dangerous interactions. Both medications can cause central nervous system depression, and when combined, they may lead to excessive sedation, respiratory depression, confusion, or even life-threatening breathing problems. According to the most recent and highest quality study 1, the work group advised against the use of benzodiazepines or trazodone for treatment of chronic insomnia disorder due to the widely known harms and adverse effects of these medications.
Some key points to consider:
- The combination of trazodone and oxycodone can increase the risk of adverse events, including respiratory depression and excessive sedation.
- The evidence supporting the efficacy of trazodone for insomnia is low-quality and outweighed by its adverse effect profile 1.
- Alternative sleep strategies, such as cognitive behavioral therapy for insomnia, sleep hygiene improvements, or different medications with fewer interaction risks, may be more suitable for patients taking oxycodone.
If you're taking oxycodone and experiencing sleep difficulties, consult your healthcare provider before adding any sleep medication. They might adjust your oxycodone dosage, timing, or suggest alternative sleep strategies. If already prescribed both medications, take them exactly as directed and report any unusual drowsiness, confusion, or breathing difficulties to your doctor immediately.
From the Research
Safety of Trazodone for Sleep in Patients Taking Oxycodone
- There are no direct studies examining the safety of trazodone for sleep in patients taking oxycodone 2, 3, 4, 5, 6.
- However, trazodone is generally considered safe for the treatment of insomnia, with a low risk of adverse effects, particularly at low doses 2, 4, 5.
- The most common side effects of trazodone are dose-dependent and include drowsiness, morning grogginess, and orthostatic hypotension 2, 4.
- Trazodone has been shown to be effective in improving sleep quality and reducing daytime drowsiness in psychiatric patients, including those with depression, anxiety, and insomnia 3, 4, 5.
- The use of trazodone in combination with other medications, such as opioids, may increase the risk of adverse effects, including respiratory depression and sedation 4.
- Therefore, caution should be exercised when prescribing trazodone for sleep in patients taking oxycodone, and patients should be closely monitored for signs of adverse effects 4, 5.
Mechanism of Action
- Trazodone promotes sleep through its antagonistic effect on 5-HT2 serotonin receptors, which is associated with an increase in deep sleep duration and improved sleep quality 5, 6.
- In contrast, hypnotics decrease slow-wave activity in sleep EEG, which is the biomarker of deep sleep, and may have a higher risk of dependence and adverse effects 5.
Clinical Considerations
- The use of trazodone for sleep in patients taking oxycodone should be individualized and based on a thorough assessment of the patient's medical history, current medications, and potential risks and benefits 4, 5.
- Patients should be educated on the potential risks and benefits of trazodone and oxycodone, and should be closely monitored for signs of adverse effects, including respiratory depression and sedation 4, 5.