It's generic, so it's considerably cheaper than many of the other widely prescribed sleep medications—about $3 for a week's supply. But because there are not studies that actually show it is safer, whether or not that is true remains unknown. First, trazodone has one distinct advantage—and possibly a few others. In addition, many physicians apparently believe that trazodone is safer than other frequently prescribed sleep medications. And while some of the insomnia drugs are classified by the FDA as controlled substances that require doctors and pharmacists to take additional steps before they're prescribed or dispensed; trazodone is not a controlled substance, so doctors can prescribe it without those constraints. While trazodone is rarely used to treat depression alone any more, it's widely prescribed, off-label, at lower doses for treating insomnia, for several likely reasons. That's compared to other sleep drugs like generic zolpidem (Ambien), generic eszopiclone (Lunesta) or generic Sonata (zalepon) that run about $15 for a week's supply.
Here are the main considerations for using drug trazodone to treat insomnia:. Of course, medication is sometimes needed for persistent insomnia—when nondrug treatment is refused, unavailable, or ineffective, or when the sleep disturbance is affecting your ability to carry out your daily activities.
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Usually, the most important consideration is managing the depression, which should be treated separay with a more effective antidepressant medication, counseling, or both. A separate drug can then be prescribed for the insomnia —either a newer sleep medication or low-dose trazodone. Studies have suggested that trazodone plus another antidepressant can improve sleep in these cases. Alternatively, trazodone might be taken alone, at a higher, antidepressant dose, to treat both problems.
(See sidebar for a full list.) If those don't work, our medical advisors recommend first trying an inexpensive over-the-counter drug containing an antihistamine such as diphenhydramine (Benadryl, Nytol, Sominex, and generic) or doxylamine (Unisom Nighttime Sleep-Aid and generic)—but only use those for a few nights. For the average person who has occasional brief bouts of insomnia, making certain changes to your lifestyle may help, including: avoiding big meals, alcohol, smoking and exercising late at night or working or watching TV in bed.
This article and related materials are made possible by a grant from the state Attorney General Consumer and Prescriber Education Grant Program, which is funded by the multistate settlement of consumer-fraud claims regarding the marketing of the prescription drug Neurontin (gabapentin).
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And some evidence suggests it can cause priapism, or persistent erection, a medical emergency that may require surgery and can lead to impotence if not treated promptly. It's true that the other drugs approved to treat insomnia can impair your ability to recall new experiences, and may even—although rarely—cause you to walk, eat, have sex, or drive a car while still essentially unconscious. And, trazodone has certain risks of its own. It might possibly weaken the immune system. Moreover, many doctors seem to believe that trazodone is less likely than even the newer sleep drugs to cause dependency and, when discontinued, renewed insomnia. In particular, it's more likely than the newer sleep drugs, particularly the short-acting ones, to leave you feeling drowsy the next day, which increases the chance of accidents. Trazodone can also cause heart-rhythm disorders. Yet there's little evidence to prove or disprove those ideas. We could find no evidence to date of those problems having been reported with trazodone. It can also cause abnormally low blood pressure and, in turn, dizziness or even fainting, particularly in seniors. Moreover, a black-box warning in the package insert notes that trazodone, like other antidepressants, can increase the risk of suicidal thoughts and behavior in children and adolescents.
Also, an effective dose range has not been studied. But the drug has not been studied for longer than six weeks, so little is known about how well it works or its safety past that point. In a few studies, trazodone is reported to improve sleep during the first two weeks of treatment.
Plus, the side effect of sedation may not actually improve depression or insomnia. Although trazodone may improve sleep at first, the effect may not continue past several weeks. Taking trazodone may also worsen sleepiness during the daytime, and morning grogginess.
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If those are ruled out—or if your insomnia persists despite treatment of the underlying problem—nondrug sleep treatments such as cognitive behavioral therapy appear to yield better, more lasting results than medication. If possible, try that before resorting to medication, which can undermine your motivation to make the behavioral changes. If your insomnia last longer than a few nights and this continues for several weeks, you should see your doctor to determine if other conditions or drug side effects could be disturbing your sleep.
If your doctor recommends sleeping pills for more than a temporary bout of insomnia without mentioning nondrug therapy, you should mention it yourself. For more on such treatment, see our Best Buy Drug report on drugs to treat insomnia.
There's very little clinical trial evidence on whether it's effective as a sleep aid when a person does not have depression, and only modest evidence when there is. Here's why trazodone has become so popular—and what to do if your doctor suggests you try it. Treatment guidelines from the American Academy of Sleep Medicine recommend trazodone for chronic insomnia without depression only when drugs like Ambien and Lunesta have failed. But numerous doctors are convinced, based mainly on their own experience, that trazodone is an appropriate sleep medication for many people, even when there's no depression.
study in the journal Sleep found it to be one of most commonly used medications to treat sleeplessness. Trazodone was first approved by the Food and Drug Administration in 1981 as an antidepressant. Today, there's no branded form of trazodone—you can only get it as a generic—but there is a long-acting version available called Oleptro. A recent U.S. What are the top prescribed drugs for insomnia— Ambien ? Lunesta? Yes, but there's another: a three-decade-old generic antidepressant called trazodone, which causes drowsiness as a potentially useful side effect. Though doctors can legally prescribe trazodone (and all drugs, for that matter), for any treatment, the drug is actually not approved to treat insomnia.Ambien uses and side effects