What is the optimal timing for taking trazodone (an antidepressant medication) before bedtime for an adult patient with a history of insomnia or depression?

Timing of Trazodone Administration for Insomnia

Take trazodone 30 minutes to 1 hour before bedtime, ensuring you have 7-8 hours available for sleep.

Optimal Timing Based on Evidence

Standard Recommendation

• Administer trazodone 30 minutes before bedtime when using the typical 50 mg dose for sleep maintenance insomnia 1
• The FDA label indicates trazodone should be taken "shortly after a meal or light snack," which supports evening administration with a bedtime snack 2
• Ensure 7-8 hours of sleep time is available to minimize next-day sedation 3

Special Timing Considerations for Sleep Onset Insomnia

• For sleep onset insomnia specifically, trazodone should be administered at least 1 hour before bedtime 4
• This earlier timing is necessary because trazodone is less effective than hypnotics for falling asleep and requires more lead time to exert its sedative effects 4

Pharmacokinetic Rationale

• Trazodone has a 3- to 9-hour half-life, which supports single nighttime dosing weighted at bedtime 5
• The medication's pharmacokinetics favor a dose concentrated in the evening rather than divided throughout the day 5

Administration Guidelines

Food Considerations

• Administer on an empty stomach to maximize effectiveness for insomnia treatment 6, 3
• However, the FDA label recommends taking it "shortly after a meal or light snack" for depression treatment 2
• This creates a practical tension: for insomnia, the guideline evidence suggests empty stomach administration, while the FDA label (for depression) suggests with food

Practical Approach

• Take trazodone 30-60 minutes before your intended sleep time
• If taking for sleep onset difficulties, lean toward the 1-hour window 4
• If taking for sleep maintenance, the 30-minute window is adequate 1

Important Caveats

Daytime Impairment Risk

• Trazodone produces small but significant impairments in short-term memory, verbal learning, equilibrium, and muscle endurance the following morning 1
• These effects persist even after 7 days of use, though objective daytime sleepiness improves by day 7 1
• Ensuring adequate sleep duration (7-8 hours) helps minimize these next-day effects 3

Dosing Context

• The timing recommendations above apply to low doses (25-100 mg) used for insomnia 7, 3
• Higher antidepressant doses (150-600 mg) may require different timing considerations 2

Critical Limitation

• The American Academy of Sleep Medicine recommends AGAINST using trazodone for insomnia, giving it a "WEAK" recommendation against use because potential harms outweigh benefits 6, 3
• Trazodone should only be considered as a third-line agent after cognitive behavioral therapy for insomnia (CBT-I) and FDA-approved hypnotics have failed 6, 3