11 Trazodone Side Effects You Should Know About

Trazodone is an antidepressant that's FDA approved to treat major depressive disorder (depression). It's also commonly prescribed off-label for insomnia (trouble sleeping). Experts believe trazodone works for depression by boosting serotonin levels in the brain.

But trazodone's effects on serotonin can also lead to some adverse effects.

Trazodone side effects at a glance

Most trazodone side effects are mild and can be managed at home. And taking a lower trazodone dosage can help lower the risk of side effects, especially in older adults.

Common trazodone side effects include:

• Drowsiness

• Dizziness

• Fatigue

• Headache

• Nausea and vomiting

• Stuffy nose

• Constipation

• Fluid retention

• Dry mouth

• Low blood pressure

• Blurred vision

• Weight changes

• Withdrawal symptoms (if stopped suddenly)

Rare but serious trazodone side effects include:

• Heart rhythm problems (arrhythmias)

• Increased risk of bleeding

• Prolonged erections (priapism)

• Serotonin syndrome

• Very low sodium levels

• Experiencing a manic episode in people with bipolar disorder

• Inability to drive or do activities that require alertness

• Glaucoma

Like other antidepressants, trazodone also has a boxed warning (the strictest warning the FDA can give a medication) for suicidal thoughts and behaviors in young adults and children.

Below, we'll review 11 notable trazodone side effects and how you might manage them. But keep in mind this isn't a full list of all possible side effects.

1. Drowsiness

A common question people ask is "does trazodone make you sleepy?" Yes, it can. Drowsiness (or sleepiness) is the most common trazodone side effect. In fact, over 40% of people taking the medication in clinical trials reported sleepiness.

In fact, trazodone is more commonly used off-label to help people sleep than it is to treat depression. When trazodone is used for sleep, it's taken before bedtime. But if you're taking trazodone for depression, you'll likely need a few doses throughout the day. In this case, your prescriber may have you take a larger portion of your total daily dose before bed.

If you find yourself feeling tired the morning after taking trazodone, try taking it a bit earlier in the evening. Just realize that you'll likely start feeling drowsy earlier. If you do feel sleepy during the day, don't drive or perform activities that require focus.

Discuss concerns of daytime sleepiness with your healthcare team, especially if it's interfering with your daily routine. They may suggest a lower dose of trazodone or switching to a different antidepressant or sleep medication.

2. Dry mouth

Dry mouth is another common trazodone side effect. This happens because trazodone blocks a chemical called acetylcholine. When medications block acetylcholine, they can cause anticholinergic side effects, such as dry mouth.

You can manage this trazodone side effect by sucking on ice chips, drinking water, or chewing sugar-free candy or gum. You can also try saliva substitute products, such as Biotene. If dry mouth becomes too bothersome, let your prescriber know.

3. Blurry vision

Blurry vision is also a common trazodone side effect. Temporary blurry vision, especially while reading, could also be a symptom of dry eye. Both dry eye and blurry vision are examples of anticholinergic side effects.

Over-the-counter (OTC) eye drops, like artificial tears, might provide dry eye relief. But these are intended for short-term use. So talk with a healthcare professional if dry eye continues. They may recommend prescription eye drops.

If you have eye pain, blind spots, or blurry vision that won't go away, seek medical attention right away. These aren't typical trazodone side effects and may indicate that something more serious is going on.

4. Dizziness

Dizziness is also a common trazodone side effect. You may also experience it shortly after starting trazodone, or after a dose change.

Dizziness may be more noticeable if you change positions too quickly. Dizziness upon standing can be a symptom of orthostatic hypotension (low blood pressure after changing positions). This is a less common trazodone side effect, but it's more likely to happen if you also take blood pressure medications.

In some cases, orthostatic hypotension can cause you to faint. Fainting can be potentially dangerous and lead to falls and accidental injury. Falls are especially dangerous in older adults because they're more at risk of experiencing disability.

To avoid orthostatic hypotension and fainting, move slowly when changing positions, like going from sitting or lying down to standing. And hold onto a sturdy surface while changing positions. If your dizziness doesn't improve or worsens, let your healthcare team know, especially if you experience any fainting or falls.

5. Nausea

Many medications cause nausea, including trazodone. Vomiting is also possible. These side effects generally aren't serious, but they can be frustrating. Taking trazodone with meals or a light snack is recommended and may help manage nausea and vomiting.

If taking your doses with food doesn't help, talk to your prescriber and pharmacist about whether nausea medications are a good option for you. There are several OTC and prescription options available.

6. Suicidal thoughts and behavior

Research on antidepressants has found that people under 25 years old have an increased risk of suicidal thoughts and behavior while taking antidepressants. Overall, the risk is low. But it may be more likely to happen in the first few months after starting trazodone or after a dosage change.

Pay attention to any changes in mood after starting trazodone. Talk to your prescriber right away if you notice any worsening of your depression or sudden change in behavior. But don't stop taking trazodone without your prescriber's guidance. Stopping your antidepressant abruptly can cause withdrawal symptoms, known as antidepressant discontinuation syndrome.

If you or someone you know struggles with substance use, help is available. Call SAMHSA's National Helpline at 1-800-662-4357 to learn about resources in your area.

7. Serotonin syndrome

As mentioned before, trazodone works by increasing the levels of a chemical called serotonin. But when serotonin levels are too high it can cause serotonin syndrome, a rare but potentially life-threatening trazodone side effect.

Taking trazodone with other medications that increase serotonin makes this complication more likely. These include other antidepressants, certain pain medications like tramadol (Conzip, Qdolo), and St. John's wort.

Symptoms of serotonin syndrome can range from mild to severe. Examples include:

• Tremors

• Sweating

• Rapid heart rate

• Fever

• Uncontrollable movements of the legs or arms

Before starting trazodone, share a list of your current medications with your healthcare team. They can help you check if other medications you take increase serotonin. And while taking trazodone, contact your healthcare team if you experience symptoms of serotonin syndrome. Mild cases of serotonin syndrome may be able to be managed at home. Severe cases may need care in a hospital setting.

8. Low sodium levels

Trazodone can lead to low sodium levels (hyponatremia). However, it's less common with trazodone than other antidepressants. Sodium is an electrolyte that's involved in many bodily functions, including blood pressure regulation.

Though the risk is low overall, hyponatremia is more likely to happen with older adults and those taking other medications that decrease sodium levels, such as diuretics.

Low sodium levels can cause symptoms like fatigue, dizziness, and disorientation. In more severe cases, seizures, confusion, and even coma can happen. Contact your prescriber right away if you experience symptoms of hyponatremia. They may ask you to get a blood test done to check your sodium levels. If your symptoms feel severe, seek emergency care.

9. Higher risk of bleeding

Trazodone can increase your risk of bleeding. This is because serotonin is involved in bodily processes that regulate bleeding. This risk is rare. But it's higher if you also take other medications that have bleeding risks. Examples include blood thinners such as Xarelto (rivaroxaban) and Pradaxa (dabigatran). Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn), can also increase your risk of bleeding.

Be sure to discuss your unique bleeding risks with your healthcare team when starting trazodone. And let them know if you experience any symptoms of bleeding while taking it, such as:

• Gum bleeding

• More frequent nosebleeds

• Easy bruising

• Cuts that takes longer than usual to stop bleeding

• Menstrual periods that are heavier than usual

• Bloody or black stools

• Blood in vomit

• Vomit that has the consistency of coffee grounds

10. Priapism

Priapism is a rare, but serious trazodone side effect that can affect your sexual health. Priapism is defined as a painful, prolonged erection that lasts for more than 4 hours. This is a medical emergency that can lead to permanent damage if not treated. Seek emergency care immediately if you have a painful erection that lasts 4 hours or longer.

11. Arrhythmias

Trazodone is one of many medications that can prolong (lengthens) the QT interval. This is the time between heart beats when the heart is resetting. Prolonging the QT interval can lead to arrhythmias. If you notice sudden lightheadedness, fainting, or palpitations while taking trazodone, seek medical help right away.

The risk of this trazodone side effect goes up if you also take other medications that have this side effect. Examples include certain antibiotics like levofloxacin and some antipsychotic medications like ziprasidone (Geodon). Your prescriber and pharmacist can help determine if you take other medications that prolong the QT interval.

Frequently asked questions