Help! Trazodone Is Not Working Well To Help Me Sleep
In our latest question and answer, our pharmacist discusses problems an individual is having with trazodone being ineffective.
I have developed onset insomnia after having a long-haul COVID infection for a few months. I was prescribed quetiapine 25mg, but it did not help. My doctor replaced quetiapine with trazodone 50mg and I took my first pill last night, but it did not make me sleepy. Will this prescription need a few nights before it starts to work?
Feb 05, 2023- Trazodone should start working for sleep on the first dose, typically within 30 minutes, especially when taken on an empty stomach. If you previously took Seroquel, trazodone may feel less effective since both medications work on similar brain receptors that control sedation. Talk to your doctor about adjusting your trazodone dose or trying alternative sleep medications if it continues not to work well for you.
Answer
Thanks for contacting us! We have actually answered a very similar question in the past (which can be found on our website), but I'll give a quick summary here for you. Click on that link if you are looking for a more detailed discussion.
Trazodone For Sleep
Trazodone is a medication that is used for the treatment of several different conditions, including depression and insomnia.
Although it is not FDA-approved to treat insomnia, it is often used 'off-label' for this purpose and there is modest evidence showing it may be beneficial for some individuals in this regard.
It is generally considered a second or third-line treatment option for the treatment of insomnia according to the American Academy of Sleep Medicine guidelines.
It also represents a good option, perhaps better than second or third-line treatment, for some individuals due to its lower risk of dependence and less severe withdrawal symptoms compared to other drugs, like benzodiazepines or benzodiazepine-like drugs (e.g., Ambien, Sonata, Lunesta).
How Does Trazodone Work And How Long Does It Take To Start Working For Sleep?
When taken for depression, it generally takes 4 to 6 weeks of consistent dosing to realize the full effects of trazodone. This is mostly due to its mechanism of action on your brain chemistry (it works by blocking serotonin reuptake and antagonizing certain serotonin receptors). This 4-6 week timeframe is on par with other antidepressant drugs, like Prozac and Zoloft.
For insomnia, however, the sedative effects of trazodone are due to a different mechanism of action than what makes trazodone work for depression. Namely, the sedative effects are due to its ability to block receptors known as alpha receptors. It also blocks histamine receptors (just like Benadryl does).
In terms of how fast trazodone works for sleep:
- The sedative effects are generally seen with the first dose (i.e., it doesn't take multiple doses over a period of time to notice the effects).
- After taking a dose, the sedative effects will start after around 30 minutes.
- Peak concentrations of the drug in the blood occur 1 hour after dosing, at which point the sedative effects will be the strongest.
- Taking trazodone with food may delay how quickly it starts to work.
Pharmacist Thoughts
You mentioned in your question you took 50mg of trazodone and it did not work.
As mentioned, when used for insomnia, trazodone generally doesn't need days of consistent dosing to work. It typically works on the very first dose.
However, there could be some things working against you that could be altering its effectiveness.
First and foremost, I highly recommend taking it on an empty stomach. It will absorb more quickly and may have more pronounced sedative effects than if you take it on a full stomach.
Additionally, and this is important, the fact that you previously took Seroquel (quetiapine) could make it feel like trazodone isn't working as well.
Seroquel is an atypical antipsychotic and works on a number of different receptors in the body, including histamine and alpha receptors, the same receptors trazodone works on.
In fact, among atypical antipsychotics, Seroquel is known to have some of the strongest effects on these receptors, which is why this drug is also used off-label to treat insomnia, just like trazodone is. So, in a way, you are now taking a drug (trazodone) that works on the same receptors that Seroquel did when you took it, but perhaps not as strong, so it's not altogether surprising to me that you are finding it not working as well as you would have hoped.
You certainly have some options here. You could try increasing the dose of trazodone (under the supervision of your doctor of course) or try other medications. Doses of up to 150mg of trazodone have been used for insomnia. Other drug options include benzodiazepine-like drugs, such as Ambien or Lunesta, mirtazapine, and amitriptyline, just to name a few.
Final Words
Thanks again for reaching out to us and let me know if there is anything else we can help with!
References & sources
Glossary — Terms in This Answer
- Off-label
- Using a medication for a purpose that has not been approved by the FDA, though doctors may prescribe it this way based on medical evidence.
- FDA-approved
- Officially authorized by the Food and Drug Administration for a specific medical use.
- Serotonin reuptake
- The process by which the brain reabsorbs serotonin; blocking this allows serotonin to remain active longer in the brain.
- Antagonizing receptors
- Blocking specific receptor sites on cells to prevent certain chemicals from attaching and triggering a response.
- Alpha receptors
- Nerve endings in the body that respond to certain chemicals and help regulate functions like sleep and blood pressure.
- Histamine receptors
- Receptor sites that respond to histamine, a chemical in the body involved in sleep, allergies, and other functions.
- Atypical antipsychotic
- A newer class of psychiatric medication used to treat conditions like schizophrenia and bipolar disorder.
- Benzodiazepine-like drugs
- Medications that work similarly to benzodiazepines to reduce anxiety and promote sleep, though with a slightly different chemical structure.
Dr. Brian Staiger, PharmD
Doctor of Pharmacy, board certified clinical pharmacist (BCPS), American Herbalist Guild, Medication Therapy Management certified
Brian Staiger, PharmD, BCPS, is a licensed pharmacist with more than 13 years of experience across retail pharmacy, clinical pharmacy, medication safety, pharmacy program development, and healthcare administration. He is the founder of HelloPharmacist.com, where he helps patients...
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