trazodone

Adjunctive therapy

Brands: DESYREL, OLEPTRO

Last reviewed 2025-12-28

Reviewed by PsychMed Editorial Team.

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Quick answers

What is trazodone?
Trazodone (brand Desyrel; ER brand Oleptro) is a serotonin antagonist and reuptake inhibitor (SARI) approved for major depressive disorder and widely used off label at low doses for insomnia in patients with depression or serious mental illness.
What is DESYREL?
DESYREL is a brand name for trazodone (other brands: OLEPTRO).
What is DESYREL (trazodone) used for?
Label indications include: Major depressive disorder (label); commonly used off label for insomnia.
What drug class is DESYREL (trazodone)?
Serotonin antagonist and reuptake inhibitor (SARI); 5-HT2 antagonism with weak SERT inhibition plus H1/α1 effects.
What strengths does DESYREL (trazodone) come in?
Immediate-release tablets: 50 mg, 100 mg, 150 mg, 300 mg.

Snapshot

Class: Adjunctive therapy
Common US brands: DESYREL, OLEPTRO
Therapeutic drug monitoring not routinely recommended.
Last reviewed: 2025-12-28

Label indications

Major depressive disorder (label); commonly used off label for insomnia.

View labelExact

Clinical Highlights

Trazodone (brand Desyrel; ER brand Oleptro) is a serotonin antagonist and reuptake inhibitor (SARI) approved for major depressive disorder and widely used off label at low doses for insomnia in patients with depression or serious mental illness. Sedation is driven by H1 and α1 antagonism at lower doses; orthostasis and next-day grogginess are common limiting factors, especially in older adults or with polypharmacy.

Low-dose-only trazodone regimens often function primarily as hypnotics; make the treatment target explicit (sleep vs depression), avoid dose escalation without a clear goal, and plan periodic taper attempts when insomnia improves.
Evidence for chronic insomnia benefit is mixed; the AASM guideline recommends against routine trazodone use for chronic insomnia (weak recommendation), so treat it as a time-limited adjunct while addressing underlying drivers (mood, substance use, pain, sleep hygiene).
The compare view and the trazodone evidence feed can help weigh sedating alternatives, and the trazodone print page can support take-home counseling.
Major depressive disorder (label)
Generic: Immediate-release tablets widely available.

Dosing & Formulations

Immediate-release tablets: 50 mg, 100 mg, 150 mg, 300 mg. Extended-release tablets (Oleptro): 150 mg, 300 mg.

Insomnia (off label): start 25–50 mg at bedtime; typical 50–150 mg nightly based on tolerability; reassess frequently and avoid dose escalation without a clear target symptom.
Depression (label): typically start 150 mg/day in divided doses; titrate gradually based on response and adverse effects; higher-dose regimens require daytime dosing and closer orthostasis monitoring.
Take shortly after food to reduce nausea; avoid abrupt discontinuation after long-term use to limit rebound insomnia and irritability.

Monitoring & Risks

Boxed warning: Antidepressants increase suicidality risk in young adults; monitor closely during initiation and titration. Sedation and cognitive slowing: Counsel about driving, falls, and additive effects with other CNS depressants.

Orthostatic hypotension/syncope: Highest risk during initiation and with dose increases; monitor in older adults and those on antihypertensives.
Priapism: Rare but serious; counsel patients to seek urgent care for erections lasting >4 hours.
QT prolongation/arrhythmia risk: Avoid combining with other QT-risk agents when possible and consider baseline ECG in higher-risk patients.

Drug Interactions

Contraindicated with MAOIs; allow ≥14-day washout to reduce serotonin syndrome risk. CYP3A4 inhibitors (ketoconazole, clarithromycin, ritonavir) increase exposure—use lower doses and monitor sedation/hypotension; inducers (carbamazepine, phenytoin) may reduce effect.

Additive CNS depression with alcohol, benzodiazepines, opioids, and sedating antipsychotics—avoid or use lowest effective doses with clear counseling.
Combined serotonergic agents (SSRIs/SNRIs, linezolid, triptans, tramadol) increase serotonin syndrome risk—monitor and educate.

Practice Notes

Prefer non-pharmacologic insomnia strategies (CBT-I, sleep hygiene) and reassess trazodone need at every visit; avoid chronic, open-ended prescribing. In older adults, start low (25 mg) and monitor orthostasis and falls; consider alternatives with clearer benefit–risk profiles.

If using for depression, ensure dosing is in antidepressant range and plan daytime dosing strategies; low-dose-only regimens often function primarily as hypnotics.
If orthostasis, falls, or QT risk limits use, switch to alternatives rather than layering additional sedatives to “treat” side effects.

References

Trazodone hydrochloride prescribing information — DailyMed (2025)
Clinical Practice Guideline for the Pharmacologic Treatment of Chronic Insomnia in Adults: An American Academy of Sleep Medicine Clinical Practice Guideline — Journal of Clinical Sleep Medicine (2017)
The efficacy and safety of trazodone for sleep problems in depressive patients — Psychopharmacology (2025)
Comparative efficacy and acceptability of 21 antidepressant drugs for major depressive disorder — The Lancet (2018)Meta-analysisdepressionefficacy