Trazodone remains among the top 25 prescribed drugs in this country. Approved by the FDA only as an antidepressant, it tends to cause intense drowsiness As a consequence it finds widespread acceptance as a treatment for insomnia rather than its authorized indication. However medical studies fail to confirm its benefits as a sleeping pill, and it lacks approval for this purpose anywhere in the world.
The American Academy of Sleep Medicine does not recommend trazodone and the widely respected Cochrane Collaboration suggests it fails to improve sleep efficiency when tested under laboratory conditions. Consumer Reports advises over-the-counter anti-histamines such as Benadryl instead of trazodone.
No established dose exists for sleep problems. While the dose for depression averages 150 mg in divided doses, doctors regularly prescribe 12.5 mg - 50 mg for insomnia with some boosting recommendations to 300 mg at night.
Developed in the 1960s, trazodone quickly developed a negative reputation due to a long list of side effects. Among the most prominent are cardiac arrhythmias, fainting, dangerous falls in blood pressure on arising and either weight gain or loss. Additionally it causes headache, blurred vision, confusion and may lead to cognitive and motor impairment.
A relatively unique and uncomfortable adverse reaction relates to prolonged painful erections or priapism lasting in excess of 6 hours. This tends to occur early in therapy, often within the first month, and at relatively low doses.
Dangerously low serum sodium concentrations may develop. Symptoms range from headache and difficulty concentrating to memory impairment, confusion and unsteadiness. Unless corrected hallucinations, seizures, respiratory arrest and death may supervene.
For those in need of a sleeping pill, prudence suggests an alternative to trazodone.