Side Effects of Trazodone: What to Expect and When to Call Your Doctor

Trazodone is one of the most widely prescribed antidepressants in the United States, with more than 24 million prescriptions filled in 2023 alone.

Originally developed to treat major depressive disorder, it is now frequently used off-label for insomnia and anxiety as well. Like all medications, trazodone can cause side effects, and knowing what to expect can help you stay safe and stick with your treatment.

Key Takeaways

• Most trazodone side effects are mild and tend to improve within the first few weeks of treatment, though some people experience more persistent effects that require medical attention.

• Drowsiness is the most common side effect and is often intentional when trazodone is prescribed for sleep, but it can become problematic if it carries into the next day.

• Certain side effects, including changes in heart rhythm, a prolonged erection (priapism), or signs of serotonin syndrome, require immediate medical attention.

What Is Trazodone?

Trazodone belongs to a class of medications called serotonin antagonist and reuptake inhibitors (SARIs).  It works by blocking certain serotonin receptors while also inhibiting the reuptake of serotonin,  a brain chemical that helps regulate mood, sleep, and emotional balance. This dual action is what makes trazodone useful for both depression and sleep.

Trazodone is available in doses of 50 mg, 100 mg, 150 mg, and 300 mg. For depression, adults typically take between 150 and 400 mg per day in divided doses. For sleep, lower doses of 50 to 100 mg are commonly used at bedtime.

Common Side Effects of Trazodone

Trazodone is generally well-tolerated, especially compared to older antidepressants. That said, most people experience at least some side effects, particularly in the early weeks of treatment.

The most frequently reported side effects include:

• Drowsiness or sedation: This is the most common effect and often improves over time, though it can persist, especially at higher doses.

• Dizziness or lightheadedness: Particularly when standing up too quickly, due to trazodone's effect on blood pressure.

• Dry mouth: A common complaint with many psychiatric medications.

• Headache: Usually mild and temporary.

• Nausea or upset stomach: Taking trazodone with food can reduce this.

• Blurred vision: Less common but reported in some users.

• Constipation: Can usually be managed with diet and hydration.

These effects are generally mild and often ease as your body adjusts during the first two to four weeks. It is advisable to take trazodone with a meal or snack to reduce stomach-related discomfort.

Next-Day Grogginess 

One side effect that can be particularly frustrating is what people often call a "hangover" effect — waking up the next morning feeling groggy, foggy, or sluggish. This is more likely at higher doses and in people who metabolize trazodone slowly. Older adults are especially prone to lingering sedation.

If next-day grogginess is a problem, speak with your prescriber. Adjusting the timing or lowering the dose may help. Never stop taking trazodone suddenly without medical guidance.

Less Common but More Serious Side Effects

While most side effects are manageable, a smaller number of people experience more significant reactions that require attention.

Orthostatic Hypotension

Trazodone can cause a sudden drop in blood pressure when you stand up, a condition called orthostatic hypotension. This can lead to dizziness or fainting. It is advisable to rise s slowly from a lying or seated position to reduce this risk.

Cardiac Effects

Trazodone may affect heart rhythm in some people, particularly those with pre-existing cardiac conditions. Irregular heartbeats (arrhythmias) have been reported, including a serious rhythm abnormality called torsade de pointes. If you have a history of heart disease, your provider should know before you start trazodone.

Hyponatremia (Low Sodium)

Trazodone, like other serotonergic medications, has been associated with hyponatremia, which is low sodium levels in the blood. This is more common in older adults. Symptoms include headache, confusion, weakness, and, in severe cases, seizures. This may occur due to a condition called SIADH (syndrome of inappropriate antidiuretic hormone secretion).

Angle-Closure Glaucoma

Trazodone may trigger a sudden increase in eye pressure in people who are predisposed to angle-closure glaucoma. Symptoms include eye pain, sudden vision changes, and seeing colored rings around lights. Seek medical attention right away if any of these occur.

Rare but Serious Side Effects

Priapism

One of the most well-known rare risks of trazodone is priapism, a prolonged, painful erection unrelated to sexual arousal. This occurs in roughly 1 in 1,000 to 1 in 10,000 people taking trazodone. If left untreated, priapism can cause permanent damage. This is a medical emergency; therefore, seek immediate care if an erection lasts longer than four hours.

Serotonin Syndrome

Serotonin syndrome is a potentially life-threatening reaction caused by too much serotonin in the brain. It is most likely when trazodone is combined with other medications that also affect serotonin, such as SSRIs, SNRIs, MAOIs, or certain pain medications.

Symptoms include rapid heart rate, high fever, muscle rigidity, confusion, and agitation. The FDA warns that treatment should be stopped immediately if serotonin syndrome is suspected.

Suicidal Thoughts

Like all antidepressants, trazodone carries an FDA black box warning about an increased risk of suicidal thoughts and behaviors in children, adolescents, and young adults.

This is most important to monitor during the first few weeks of treatment or after a dose change. If you or someone you know experiences new or worsening thoughts of self-harm, contact a healthcare provider immediately or call or text 988 (the Suicide and Crisis Lifeline).

Side Effects in Older Adults

Older adults face a higher risk of trazodone side effects, including sedation, falls, low blood pressure, and low sodium.

The recommended dose for older patients should generally not exceed 100 mg per day. Research has also associated trazodone with an increased fall risk in elderly patients, which can lead to hip fractures and other serious injuries.

Side Effects vs. Antidepressant Benefits

One reason trazodone is often preferred over SSRIs is its more favorable side effect profile in certain areas.

Research has found that trazodone was associated with low levels of sexual dysfunction and weight gain;  these two side effects commonly lead people to stop SSRIs. This can make trazodone a useful alternative for people who have struggled with these issues on other antidepressants.

When to Contact Your Doctor

While many side effects are manageable, some warrant a call to your healthcare provider. These include:

• Persistent drowsiness that interferes with daily activities

• Dizziness or fainting when standing

• Signs of low sodium: confusion, weakness, or seizures

• New or worsening depression or anxiety

• Eye pain or sudden vision changes

Seek emergency care immediately if you experience:

• Prolonged or painful erection (priapism)

• Signs of serotonin syndrome (fever, rapid heart rate, muscle rigidity, confusion)

• Irregular or rapid heartbeat

• Thoughts of self-harm

Managing Side Effects Day-to-Day

Several practical steps can help reduce common side effects:

• Take trazodone with food to minimize nausea

• Rise slowly from sitting or lying positions to prevent dizziness

• Avoid alcohol, as it can amplify trazodone's sedating effects and increase side effect risk

• Take trazodone at bedtime if sedation is a concern

• Keep all follow-up appointments so your provider can monitor your response and adjust the dose if needed

If you're considering whether trazodone is right for you, speaking with a board-certified psychiatrist is the best next step. Blossom Health connects you with licensed psychiatric providers for virtual, in-network care, making it easy to get personalized guidance from home. Learn more at https://www.joinblossomhealth.com/.

Medical Disclaimer

This article is for informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or qualified healthcare provider with any questions about a medical condition. If you are experiencing a mental health crisis, call or text 988.

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