Tools for Practice Outils pour la pratique

#302 Still awake? Trazodone for insomnia

Is trazodone effective and safe for insomnia?

Besides a “small” effect on short-term sleep quality and perhaps 0.3 less awakenings per night, trazodone does not have consistent benefits on sleep over placebo. There is no evidence that trazodone results in fewer falls than other sedative-hypnotics.  

CFPCLearn Logo

Reading Tools for Practice Article can earn you MainPro+ Credits

La lecture d'articles d'outils de pratique peut vous permettre de gagner des crédits MainPro+

Join Now S’inscrire maintenant

Already a CFPCLearn Member? Log in

Déjà abonné à CMFCApprendre? Ouvrir une session

  • Results statistically different unless specified.
  • Efficacy:
    • Trazodone versus placebo: most recent systematic review, 7 randomized, placebo-controlled trials (RCTs) of trazodone (ages 18-75, 16-306 participants, dose 50-200mg for 1-12 weeks).¹
      • Time to fall asleep: No difference.
      • Number of awakenings: 0.31 fewer.
      • Sleep quality: Standard mean difference=0.34 at 7 days to 6 months over placebo (clinical meaning unclear) (3 RCTs). No difference at 6 months (1 RCT).
      • Other outcomes inconsistent. Examples:
        • Total sleep time: no difference in 2 RCTs, improved at 6 weeks in 1 RCT.
        • Daytime functioning: no difference or improved depending on RCT.
    • Trazodone versus zolpidem: 1 RCT (181 patients) showed no difference in any outcome at 2 weeks but did not use all randomized patients.¹
    • Another systematic review with 7 RCTs (including 3 in patients with depression) had similar findings.²
  • Safety (all retrospective observational studies):
    • Falls:
      • Increased risk compared to no antidepressant (2 studies):
        • Trazodone 244 falls versus no antidepressant 131 falls per 100 person-years, borderline statistical significance [adjusted rate ratio=1.2 (1.0 to 1.4)].³
        • Trazodone falls 5.3% versus 3.5% no antidepressant.4
      • No difference compared to antipsychotics (1 study).5
      • No difference in fall-related emergency or hospital admissions at 90 days versus benzodiazepines (1 study).6
    • Mortality increased compared to no antidepressant (12% versus 7%).4
  • All antidepressant classes have been associated with falls/fractures, with similar fall risk to benzodiazepines and z-drugs.7,8
  • Guidelines recommend against trazodone for insomnia.9,10
  • Sleep restriction therapy can be an effective treatment for insomnia in primary care.11

John Thompson November 22, 2021


Ronald Maier January 10, 2022

I will not prescribe trazadone for insomnia

Ronald Maier January 10, 2022

No Trazadone for insomnia

Latest Tools for Practice
Derniers outils pour la pratique

#367 Oral Calcitonin Gene-related Peptide Antagonists: A painfully long name for the acute treatment of migraines

What are the risks and benefits of ubrogepant for the acute treatment of episodic migraines?
Read Lire 0.25 credits available Crédits disponibles

#366 Looking for Closure: Managing simple excisions or wounds efficiently

What are some options for efficiency in wound closure?
Read Lire 0.25 credits available Crédits disponibles

#365 Shrooms for Glooms: Evidence for psilocybin for depression

What are the benefits and harms of psilocybin for treatment-resistant/recurrent depression?
Read Lire 0.25 credits available Crédits disponibles

This content is certified for MainPro+ Credits, log in to access

Ce contenu est certifié pour les crédits MainPro+, Ouvrir une session

  • Adrienne J Lindblad BSP ACPR PharmD
  • Jennifer Potter MD CCFP

1. Everitt H, Baldwin DS, Stuart B, et al. Cochrane Database System Rev. 2018; 5:CD010753.

2. Yi XY, Ni SF, Ghadami MR, et al. Sleep Med. 2018; 45:25-32.

3. Thapa PB, Gideon P, Cost TW, et al. New Engl J Med. 1998; 339:875-82.

4. Coupland C, Dhiman P, Morriss R, et al. BMJ. 2011; 343:d4551.

5. Watt JA, Gomes T, Bronskill SE, et al. CMAJ. 2018 Nov 26; 190:E1376-83.

6. Bronskill SE, Campitelli MA, Iaboni A, et al. J Am Geriatr Soc. 2018; 66:1963-71.

7. Woolcott JC, Richardson KJ, O’Wiens M, et al. Arch Intern Med. 2009; 169(21):1952-60.

8. Seppala LJ, Wermelink AMAT, de Vries M, et al. J Am Med Dir Assoc. 2018; 19(4):372.e1-372.e8

9. Mysliwiec V, Martin JL, Ulmer CS, et al. Ann Intern Med. 2020; 172:325-36.

10. Sateia MJ, Buysse DJ, Krystal AD, et al. J Clin Sleep Med. 2017; 13(2):307-49.

11. Allan GM, Lindblad AJ, Varughese J. Can Fam Physician. 2017; 63(8):613.

Authors do not have any conflicts of interest to declare.

Les auteurs n’ont aucun conflit d’intérêts à déclarer.