Medication Safety Review: Trazodone

Treatments
Written By Anna Glezer, M.D.
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Authored by:

Anna Glezer, M.D.

This series will review a medication (commonly used in mental health treatment) weekly to describe its safety profile and answer five important questions.

Today we focus on trazodone.

What is it and what is it used for?

Trazodone is a medication in the antidepressant class. However, its most common use is as a sleep aid. The doses of trazodone when used as a sleep aid are generally lower than the dose that which would be used if it were being prescribed as an antidepressant. Common ranges are 25mg to 100mg at bedtime.

Because sleep is so essential in pregnancy and postpartum, it is important to evaluate the safety of sleep aid medications and compare that to the risks of poor sleep.

How safe is it in early pregnancy?

One study from Canada attempted to answer this question by examining 147 women taking trazodone (and its cousin nefazedone, rarely prescribed in the United States). Investigators did not find any association with birth defects.

How safe is it in later pregnancy and delivery? Are there any long-term consequences of this medication?

Unfortunately, there is very little data to answer these questions authoritatively. One reassuring factor is that unlike other medications that are taken every day, trazodone is usually used “as needed,” meaning to manage sleep problems only on the nights that they occur. Therefore, it is reasonable to believe that if you are taking this medication intermittently, and do not use it around the time of delivery, you can minimize any potential risk of a withdrawal syndrome for the infant (a withdrawal syndrome is the most common side effect of taking other types of antidepressants around the time of delivery). There is no data looking at the long-term outcomes of children exposed to trazodone in utero.

Is it safe in breastfeeding?

The National Institute of Health states that trazodone is not expected to cause any problems in infants older than 2 months, especially with doses of the medication at 100mg or less.

References:
Einarson, A. et. al. A multicenter prospective controlled study to determine the safety of trazodone and nefazodone use during pregnancy. Canadian Journal of Psychiatry 48 (2003): 106-110.

Anna Glezer, M.D.

Dr. Glezer began her training at Harvard and then transitioned to the University of California, San Francisco, where she has been a practicing physician, teacher, mentor, and is an associate professor. She is board certified in adult and forensic psychiatry, a member of the American Psychiatric Association, and the immediate past President of the Northern California Psychiatric Society.

She has worked with hundreds of women going through the emotional challenges of conception, pregnancy, loss, and postpartum. She has been interviewed for, and her written work has appeared on multiple leading sites, including Huffington Post, Fit Pregnancy, Health Line, Help Guide, and more. She has presented at local and national conferences and published in academic journals. Several years ago, she established the annual Bay Area Maternal Mental Health Conference and launched the educational website Mind Body Pregnancy, aimed to inform women, their partners, and their providers about mental health and emotional issues common in the reproductive years.

She began her private practice to help women throughout the Bay Area access reproductive mental health services and is really passionate about helping as many women as possible.

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Medication Safety Review: Zolpidem (Ambien)