Desyrel® / Oleptro®
Trazodone HCl
Version 2025-04 · Last reviewed April 1, 2025 · Methodology
List Price
$20
With Insurance
$4
The Short Version
Evidence summary
Desyrel (Trazodone HCl) is a SARI (Serotonin Antagonist and Reuptake Inhibitor) prescribed for Major depressive disorder (FDA-approved) and Insomnia (off-label — most common use). FDA-approved in 1981.
Sedation begins within 30-60 minutes. For insomnia, take 30 minutes before desired sleep. Antidepressant effects take 2-6 weeks at higher doses.
The most commonly reported side effects are Drowsiness / sedation (20-40%), Dry mouth (15-20%), Dizziness / lightheadedness (10-20%). This IS the intended effect when prescribed for insomnia. Take at bedtime. Morning grogginess may occur.
Most research was funded by the manufacturer — independent replication is limited.
What This Really Costs
Long-term cost projection based on current pricing
Monthly
$10
$4 w/ insurance
without insurance
Annual
$120
$48 w/ insurance
without insurance
10 Years
$1.2K
$480 w/ insurance
without insurance
30 Years
$3.6K
$1.4K w/ insurance
without insurance
Lifestyle alternative: $0/month in prescriptions. CBT-I (Cognitive Behavioral Therapy for Insomnia) — Equivalent to medications short-term; superior long-term.
The average American retiree spends $165,000 on healthcare over their lifetime (Fidelity, 2024). Informed choices today compound over decades.
Quick Answers
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Related Evidence
Explore related medications reviewed on EvidentMeds
FDA Black Box Warning
SUICIDALITY IN CHILDREN AND YOUNG ADULTS
Antidepressants increased the risk of suicidal thinking and behavior in children, adolescents, and young adults in short-term studies. This warning applies to all antidepressants including trazodone, though trazodone's risk may be lower than SSRIs.
Strict Contraindications
How It Works
Trazodone has a complex pharmacology that depends on dose. At low doses (25-100mg, as used for insomnia), it primarily blocks serotonin 5-HT2A receptors and histamine H1 receptors — producing sedation without significant serotonin reuptake inhibition. At higher doses (150-300mg+, as used for depression), serotonin reuptake inhibition becomes more prominent, adding antidepressant effects.
Why the side effects happen
Morning grogginess comes from the long half-life (5-9 hours) and persistent H1/5-HT2A blockade. Orthostatic hypotension and dizziness come from alpha-1 blockade. Priapism (rare but serious) occurs because alpha-1 blockade in penile blood vessels prevents vasoconstriction, trapping blood in the corpus cavernosum.
When Will I Feel It?
Sedation begins within 30-60 minutes. For insomnia, take 30 minutes before desired sleep. Antidepressant effects take 2-6 weeks at higher doses.
Sedation begins. Take 30 minutes before bed with a light snack to improve absorption and reduce dizziness.
Sleep quality typically improves within the first 1-2 weeks. Sleep architecture (deep sleep, REM) is preserved or improved.
At doses ≥150mg, antidepressant effects develop. This timeframe is similar to SSRIs.
Adherence Note
For insomnia, trazodone works best when taken consistently at the same time each night. However, unlike antidepressants, it can also be used on an as-needed basis for occasional insomnia at your doctor's discretion.
Medical Disclaimer
The information on this page is compiled from publicly available clinical trial data, FDA prescribing information, and peer-reviewed literature. It is provided for educational purposes only and does not constitute medical advice, diagnosis, or treatment recommendations. Individual responses to medications vary. Always consult a qualified healthcare provider before starting, stopping, or changing any medication.
Metabolic & Lifestyle Alternatives
Evidence-Based Alternatives for Insomnia
CBT-I (Cognitive Behavioral Therapy for Insomnia) is considered the gold standard first-line treatment for chronic insomnia by every major medical guideline — outperforming sleep medications in long-term outcomes. Most people with chronic insomnia have never been offered CBT-I.
Important context: Evidence quality varies across these approaches. Some are well-studied with randomized controlled trial data; others are based on observational or smaller studies. These interventions are not guaranteed to replace medication for all patients. Discuss with your doctor whether any of these are appropriate for your clinical situation.
CBT-I (Cognitive Behavioral Therapy for Insomnia)
A structured program (typically 4-8 sessions) that addresses the behavioral and cognitive factors maintaining insomnia. Includes sleep restriction, stimulus control, cognitive restructuring, and relaxation training. Available in-person, online, and through apps (e.g., CBT-i Coach).
Equivalent to medications short-term; superior long-term. 70-80% of patients show significant improvement. Effects persist after treatment ends (unlike medications).
Sleep hygiene optimization
Consistent wake time, cool dark bedroom, no screens 1 hour before bed, no caffeine after noon, no alcohol within 3 hours of bedtime. Foundation for all other interventions.
Sleep hygiene alone has modest effect; most powerful when combined with CBT-I
Exercise (timed correctly)
Regular aerobic exercise improves sleep quality significantly. Timing matters: morning or afternoon exercise is beneficial; intense evening exercise may worsen sleep.
Meta-analysis: moderate aerobic exercise improves sleep onset latency by 10 min, total sleep time by 30 min
Magnesium supplementation
Magnesium glycinate or threonate before bed may improve sleep quality, particularly in those with deficiency (common in Western diets).
Modest improvements in sleep quality in elderly with low magnesium levels
Light exposure management
Bright light exposure in the morning and dim/warm light in the evening helps entrain the circadian rhythm. Blue light blocking glasses in the evening may help.
Morning bright light advances sleep onset by 20-30 minutes in delayed sleep phase
How It Compares
Trazodone is the most prescribed medication for insomnia in the US — despite never being formally approved for this use. Its appeal comes from being cheap, non-addictive, and having a favorable sleep architecture profile (preserves deep sleep and REM).
Strengths
- Extremely cheap ($4 generic)
- Non-addictive — no DEA schedule
- Preserves normal sleep architecture (unlike benzodiazepines and Z-drugs)
- No next-day cognitive impairment at low doses
- Dual use for depression + insomnia
Weaknesses
- Off-label for insomnia — limited rigorous trial data for this use
- Morning grogginess if dose too high
- Orthostatic hypotension — fall risk in elderly
- Priapism risk (rare but serious)
- Complex pharmacology makes dose-response unpredictable
Clinically Preferred Alternatives
Global Prescribing & Pricing
Trazodone is one of the most prescribed medications for insomnia globally, despite this use being off-label
United States
$4-20/mo
#1 prescribed sleep medication; almost always off-label for insomnia
Preferred by insurers over branded sleep aids due to extremely low cost
Usually covered
United Kingdom
~$1-3/mo
Used for both depression and insomnia; CBT-I preferred as first-line for insomnia per NICE
Short-term use recommended; CBT-I referral expected
Covered by NHS
France
~$2-5/mo
Used for depression; less commonly prescribed for insomnia alone
Sleep hygiene counseling expected alongside prescribing
Covered by Sécurité Sociale
Germany
~$3-8/mo
Used for both depression and insomnia
CBT-I increasingly promoted as first-line
Covered by GKV
Japan
~$5-15/mo
Prescribed primarily for depression; less common for insomnia
Japan has separate approved insomnia medications
Covered by JHIS
Trazodone is the most prescribed sleep medication in the US — but it was never formally studied or approved for insomnia in the large trials that would normally be required. It became the default because it was cheap ($4), non-addictive, and available when controlled sleep medications were the only alternatives. The UK and Germany now recommend CBT-I as first-line for chronic insomnia.
Clinical Trials & Funding
Understanding who funds research helps contextualize results. Industry-funded trials are not automatically invalid — they undergo the same FDA review — but declared conflicts and sponsor effects are worth knowing. All linked trials can be verified on ClinicalTrials.gov.
Funding Sources
Trazodone was originally FDA-approved for depression in 1981. Most pivotal trials were funded by the original manufacturer (Mead Johnson, later Bristol-Myers Squibb). Its widespread use for insomnia developed organically through off-label prescribing — there are no large industry-funded trials specifically supporting its use as a sleep aid.
Declared Conflicts of Interest
The original depression trials were industry-funded. However, trazodone has been generic since 1986 — no company has a financial incentive to fund new trials. Its use for insomnia is based on relatively small studies, clinical experience, and the fact that sedation is its dominant side effect at low doses. It became the #1 prescribed sleep medication largely because it was cheap, non-addictive, and available when there were few alternatives.
Key Efficacy Results
Moderate efficacy for insomnia at 25-100mg; minimal antidepressant effect below 150mg. Improves sleep without suppressing deep sleep or REM — unlike many alternatives.
Referenced Studies
Each study carries a Cochrane RoB-2 risk-of-bias badge — tap the badge for details.
Evidence & Transparency
Cochrane RoB-2 (Risk of Bias)
Badges reflect an editorial assessment using Cochrane's RoB-2 tool domains: randomization, intervention deviation, missing data, outcome measurement, and selective reporting. These are not certified Cochrane reviews. Learn more ↗
CMS Open Payments
Manufacturer payment disclosures are reported via the CMS Sunshine Act. Disclosure is legally required and does not imply bias or misconduct. Language uses "may," "suggests," or "appears" — never definitive clinical claims. CMS Open Payments ↗
Live Clinical Trials
Live from ClinicalTrials.gov · refreshed every 4 hours
Currently enrolling, active, and recently completed studies involving Trazodone HCl. Data is pulled directly from the U.S. National Library of Medicine.
Recent Research
Live from PubMed · peer-reviewed literature · refreshed every 4 hours
Most recently indexed clinical trials and systematic reviews mentioning Trazodone HCl in PubMed.
Source Documentation
Structured citations for referenced clinical trials
Each referenced trial is listed with its registry ID, funding source, and bias assessment. Use the copy button to generate a formatted citation.
| Trial | Registry ID | Cite |
|---|---|---|
| Trazodone for Insomnia (Meta-analysis) | PMID:29315562 | |
| Trazodone Sleep Architecture Study | PMID:28093778 |
Bias ratings use Cochrane RoB-2 methodology. Editorial assessment — not a certified Cochrane review.
Our MethodologyMedical Disclaimer
The information on this page is compiled from publicly available clinical trial data, FDA prescribing information, and peer-reviewed literature. It is provided for educational purposes only and does not constitute medical advice, diagnosis, or treatment recommendations. Individual responses to medications vary. Always consult a qualified healthcare provider before starting, stopping, or changing any medication.
Common Side Effects
While taking this medication, you may experience the following common side effects. We've included tips on how to manage them.
Drowsiness / sedation
20-40%This IS the intended effect when prescribed for insomnia. Take at bedtime. Morning grogginess may occur.
Dizziness / lightheadedness
10-20%Rise slowly from bed; take 30 minutes before sleep
Dry mouth
15-20%Keep water at bedside; sugar-free gum may help
Headache
10%Usually mild and self-limiting
Nausea
5-10%Taking with a small snack reduces nausea significantly
Blurred vision
5-6%Usually mild; tell your doctor if persistent
Orthostatic hypotension
5%Blood pressure drops when standing; rise slowly, especially at night. Sit on edge of bed before standing.
Weight change
MinimalLess weight gain than most antidepressants and sleep medications
Serious Adverse Effects
- • Priapism (painful prolonged erection — rare but medical emergency; ~1 in 6,000-8,000)
- • Cardiac arrhythmias (QT prolongation — rare, dose-dependent)
- • Serotonin syndrome (when combined with serotonergic drugs)
- • Suicidal ideation (FDA black box — antidepressant class warning, though trazodone risk appears lower)
- • Orthostatic hypotension leading to falls (especially in elderly)
Drug Interactions
Major Interactions (Avoid)
Moderate Interactions (Caution)
Food Interactions
When to Contact Your Doctor
This medication requires ongoing medical supervision. The following situations warrant a prompt conversation with your prescribing physician — do not wait for your next scheduled appointment.
Contact soon if you notice
- Priapism (painful prolonged erection — rare but medical emergency; ~1 in 6,000-8,000)
- Cardiac arrhythmias (QT prolongation — rare, dose-dependent)
- Serotonin syndrome (when combined with serotonergic drugs)
- Suicidal ideation (FDA black box — antidepressant class warning, though trazodone risk appears lower)
- Rebound insomnia (worse sleep for 1-2 weeks)
Also discuss if you want to
- Review whether this medication is still appropriate for you
- Consider dosage adjustments based on response
- Explore lifestyle or non-drug alternatives
- Understand stopping or tapering options
- Plan monitoring labs and follow-up
In the US, call 911 or go to the nearest emergency room for severe symptoms. Poison Control: 1-800-222-1222.
Special Populations
Safety classifications for specific groups — discuss with your provider before use.
Category C. Limited human data. Use only if benefit outweighs risk.
Excreted in breast milk. Monitor infant for sedation.
Sleep disruption is one of the most common menopause symptoms. Trazodone is frequently prescribed for menopausal insomnia. Ask whether your sleep problems might improve with hormonal management or CBT-I (cognitive behavioral therapy for insomnia) before committing to long-term sleep medication.
Not FDA-approved for children. Black box warning for suicidality in young people.
Start at 25mg. Higher risk of orthostatic hypotension, falls, and fractures. Morning sedation more pronounced.
Some accumulation in renal impairment; start low.
Hepatically metabolized; reduce dose in liver disease.
FDA Adverse Event Reports
Patient-filed reports from the FDA FAERS database · refreshed daily
Community Reports
User-reported experiences — anonymous & anecdotal
Medical Disclaimer
The information on this page is compiled from publicly available clinical trial data, FDA prescribing information, and peer-reviewed literature. It is provided for educational purposes only and does not constitute medical advice, diagnosis, or treatment recommendations. Individual responses to medications vary. Always consult a qualified healthcare provider before starting, stopping, or changing any medication.
Stopping This Medication Safely
While trazodone withdrawal is generally milder than SSRIs or SNRIs, abrupt discontinuation after regular use can cause rebound insomnia, anxiety, agitation, and irritability. Gradual tapering is recommended.
What Published Research Shows About Stopping This Medication
This summarizes what published research documents — it is not personal medical advice. Any changes to your medication require discussion with your prescribing physician.
- ·If used at low doses for insomnia (25-100mg), published approaches describe reducing by 25mg every 1-2 weeks
- ·If used at antidepressant doses (150-300mg), taper more gradually — reduce by 50mg every 2-4 weeks
- ·Rebound insomnia is common in the first 1-2 weeks after stopping — this is temporary
- ·Building CBT-I habits before tapering significantly improves success rates
Warning Symptoms — Contact Your Doctor If You Experience:
- Rebound insomnia (worse sleep for 1-2 weeks)
- Anxiety or agitation
- Irritability
- Nausea
- Headache
Never change or stop a medication without consulting your prescribing physician.
Questions for Your Doctor
Questions to Ask
- 1.Should I try CBT-I before taking medication for insomnia?
- 2.Am I taking trazodone for sleep or depression — and does that change anything?
- 3.Is there an underlying cause for my insomnia (sleep apnea, menopause, anxiety)?
- 4.How long should I plan to take this?
- 5.What happens when I want to stop?
Lab Tests to Request
- Sleep diary (2 weeks)
- Sleep study (polysomnography — if sleep apnea suspected)
- Thyroid function (hyperthyroidism causes insomnia)
- Depression screening (PHQ-9)
Medical Disclaimer
The information on this page is compiled from publicly available clinical trial data, FDA prescribing information, and peer-reviewed literature. It is provided for educational purposes only and does not constitute medical advice, diagnosis, or treatment recommendations. Individual responses to medications vary. Always consult a qualified healthcare provider before starting, stopping, or changing any medication.
Frequently Asked Questions About Desyrel® / Oleptro®
- What is Desyrel® / Oleptro® used for?
- Desyrel® / Oleptro® (Trazodone HCl) is a SARI (Serotonin Antagonist and Reuptake Inhibitor) manufactured by Generic. FDA-approved indications include: Major depressive disorder (FDA-approved); Insomnia (off-label — most common use); Anxiety (off-label).
- What are the common side effects of Desyrel® / Oleptro®?
- Common side effects of Desyrel® / Oleptro® include: Drowsiness / sedation (20-40%); Dizziness / lightheadedness (10-20%); Dry mouth (15-20%); Headache (10%); Nausea (5-10%).
- How much does Desyrel® / Oleptro® cost?
- Desyrel® / Oleptro® list price is approximately $20. With insurance it typically costs $4; without insurance approximately $4-15.
- Who funded the clinical trials for Desyrel® / Oleptro®?
- Trazodone was originally FDA-approved for depression in 1981. Most pivotal trials were funded by the original manufacturer (Mead Johnson, later Bristol-Myers Squibb). Its widespread use for insomnia developed organically through off-label prescribing — there are no large industry-funded trials specifically supporting its use as a sleep aid.
- How strong is the clinical evidence for Desyrel® / Oleptro®?
- Key studies: Multiple depression RCTs (1980s-90s); Yi et al. 2018 (insomnia meta-analysis). Moderate efficacy for insomnia at 25-100mg; minimal antidepressant effect below 150mg. Improves sleep without suppressing deep sleep or REM — unlike many alternatives. Potential conflicts of interest: The original depression trials were industry-funded. However, trazodone has been generic since 1986 — no company has a financial incentive to fund new trials. Its use for insomnia is based on relative.
- Are there non-drug alternatives to Desyrel® / Oleptro®?
- CBT-I (Cognitive Behavioral Therapy for Insomnia) is considered the gold standard first-line treatment for chronic insomnia by every major medical guideline — outperforming sleep medications in long-term outcomes. Most people with chronic insomnia have never been offered CBT-I. See the Alternatives tab for full details.
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