Trazodone is an antidepressant, in 50 mg and 100 mg capsules, that is prescribed at least as often for sleep as for depression. At low doses it is sedating; at higher doses it treats depression and anxiety. It is Schedule 5, and it is not a sleeping tablet in the usual sense.
What is Trazodone?
The South African Medicine Price Registry lists trazodone hydrochloride as Schedule 5 capsules in 50 mg and 100 mg, under brands including Molipaxin, Aspen Trazodone, Biotech Trazodone, Sariprev, Trezot and Zerpas. All contain the same active ingredient.
Trazodone is a serotonin antagonist and reuptake inhibitor (SARI) — its own class, related to but distinct from the SSRIs.
Its dose-dependent behaviour is the key to understanding it, and it explains almost every question people have about it.
At low doses — typically 25 to 100 mg at night — trazodone mainly blocks histamine and certain serotonin and adrenaline receptors. The effect is straightforwardly sedating. At these doses it is not really acting as an antidepressant at all; it is being used for its side effect.
At higher doses — usually 150 mg and upwards — enough serotonin reuptake inhibition occurs for the antidepressant effect to emerge.
So a 50 mg capsule at bedtime and a 300 mg daily dose are doing quite different jobs, which is why people compare notes and find their experiences do not match.
Why it is used for sleep so widely: because it is not a benzodiazepine or a Z-drug. It does not cause dependence in the way zolpidem or lorazepam do, tolerance to its sedating effect develops slowly if at all, and there is no meaningful withdrawal or rebound insomnia. For long-term insomnia, that is a real advantage — the standard sleeping tablets are only meant for a few weeks, and trazodone can be continued.
Schedule 5 reflects its class rather than a strong misuse risk; trazodone is not sought after recreationally and produces no euphoria.
What is Trazodone commonly used for?
- Insomnia — by far its most common use in practice, particularly where sleep problems accompany depression, anxiety or chronic pain, and where a benzodiazepine or Z-drug is unsuitable for long-term use.
- Major depression, at higher doses. It is particularly useful where a person is depressed and sleeping badly, since one medicine addresses both.
- Anxiety, including generalised anxiety and anxiety alongside depression.
- Depression with agitation, where its calming effect helps.
- Sleep disturbance in older adults, where it is often preferred to benzodiazepines because it carries less confusion and falls risk — though it is not free of either.
- Sleep problems in PTSD, including nightmares, in some prescribing.
- Off-label, sometimes for chronic pain conditions where poor sleep is central. It is not a painkiller — searches for “trazodone for pain” usually reflect this indirect use, or confusion with amitriptyline, which does have a direct role in nerve pain.
Two points shape whether treatment goes well:
For depression it takes weeks. The sedation arrives on night one; the mood effect takes two to four weeks, often six. Judging the medicine in the first week is judging the wrong thing.
For sleep, take it well before bed. Trazodone tends to work best taken one to two hours before you intend to sleep, not as you get into bed — and next-morning grogginess is the commonest complaint, usually improved by taking it earlier rather than by stopping.
How Trazodone fits into this medicine category
| Group | Examples | Notes |
|---|---|---|
| SARIs | Trazodone | Sedating at low dose; antidepressant at higher |
| SSRIs | Escitalopram, sertraline, fluoxetine | First-line for depression; may disturb sleep |
| Tricyclics | Amitriptyline (Trepiline) | Sedating; also used for nerve pain |
| SNRIs | Venlafaxine, duloxetine | Depression, anxiety, nerve pain |
| Z-drugs | Zolpidem (Nurika) | Short-term insomnia; dependence risk |
| Gabapentinoids | Pregabalin, gabapentin | Nerve pain, anxiety |
| Sedating antihistamines | Promethazine | Occasional short-term sleep aid |
Trazodone and amitriptyline are frequently confused. Both are older, sedating, and prescribed at low doses for sleep. Amitriptyline additionally has a well-established role in nerve pain; trazodone does not. Amitriptyline generally causes more dry mouth, constipation and urinary hesitancy.
See the mental health and neurology medicines hub.
What to check before using Trazodone
Tell your doctor or pharmacist if you:
- Have a heart condition, particularly a heart rhythm problem or long QT interval, or a recent heart attack. Trazodone can prolong the QT interval.
- Take other medicines affecting heart rhythm, or other serotonergic medicines — SSRIs, SNRIs, tramadol, triptans, linezolid, St John’s Wort. Combining them raises the risk of serotonin syndrome.
- Take or have recently taken an MAOI antidepressant. A gap is required.
- Take other sedatives — benzodiazepines, opioids, sleeping tablets — or drink alcohol. The sedation is additive and can be significant.
- Have liver or kidney disease.
- Have epilepsy.
- Have bipolar disorder, or a family history of it. Antidepressants can trigger mania.
- Have glaucoma or prostate enlargement.
- Are elderly — low sodium, dizziness and falls are more likely.
- Are under 25. Antidepressants carry a small increased risk of suicidal thoughts early in treatment in younger people, which warrants closer monitoring in the first weeks.
- Are pregnant, planning pregnancy or breastfeeding.
- Are due for surgery, or take warfarin or a blood thinner.
Practical points:
- Take it with or shortly after food, which reduces dizziness.
- For sleep, take it one to two hours before bed.
- Do not drive until you know how it affects you. Next-morning impairment is real.
- Get up slowly from sitting or lying — dizziness on standing is common early on.
- Do not stop suddenly. Stopping abruptly after regular use can cause anxiety, agitation, sleep disturbance, nausea and flu-like symptoms. Reduce gradually with your doctor.
- Avoid alcohol, particularly at first.
Possible cautions and when to ask a pharmacist or doctor
The commonest effects are drowsiness, dizziness, dry mouth, headache, blurred vision, nausea and dizziness on standing. Most ease over the first week or two.
Get emergency help for:
- A painful erection lasting more than 2 hours (priapism). This is rare but is a genuine emergency — delay can cause permanent damage. It is a specific and well-documented trazodone effect, and worth knowing about in advance rather than discovering during it.
- Fainting, palpitations, or an irregular or very fast heartbeat.
- Agitation with fever, sweating, shivering, muscle twitching, rapid heartbeat and confusion — possible serotonin syndrome.
- A seizure.
- Swelling of the face, lips or tongue, or difficulty breathing.
- Thoughts of harming yourself. Contact someone immediately — a doctor, an emergency department, or the South African Depression and Anxiety Group helpline.
Seek prompt advice for:
- Confusion, marked drowsiness, headache with nausea, or unsteadiness — possible low sodium, more likely in older people.
- New or worsening agitation, restlessness, or unusual elevation of mood.
- Unusual bruising or bleeding.
- Yellowing of the skin or eyes.
- A rash.
Contact your doctor if there is no improvement in mood after four to six weeks, if morning grogginess persists despite taking it earlier, if sleep is not improving, or if you want to stop — so it can be tapered rather than stopped abruptly.
Related medicine guides
Frequently asked questions
What is trazodone 50 mg used for? Most often insomnia. At low doses trazodone is sedating rather than antidepressant, so 50 mg at night is usually being prescribed for sleep.
What is trazodone 100 mg used for? Sleep at the lower end, and depression or anxiety as the dose is built up. Antidepressant effect generally needs 150 mg or more.
Is trazodone a sleeping tablet? Not in the usual sense. It is an antidepressant whose sedating effect is used for sleep — with the advantage that it does not cause dependence or rebound insomnia the way Z-drugs and benzodiazepines do.
Is trazodone 50 mg used for pain? It is not a painkiller. It is sometimes used where poor sleep worsens chronic pain. Amitriptyline, which is often confused with it, does have a direct role in nerve pain.
How long before it works? For sleep, the first night. For depression, two to four weeks, sometimes six.
Is it addictive? No. It causes no euphoria and is not sought recreationally. But do not stop it suddenly after regular use — reduce gradually.
Why am I groggy in the morning? The commonest complaint. Take it one to two hours before bed rather than at bedtime, and speak to your doctor if it persists.
Can I drink alcohol with it? Best avoided. The sedation is additive and can be marked.