Medication Safety Review Series: Trazodone

Learn about the safety of using trazodone during pregnancy & delivery, its long-term consequences, and breast-feeding considerations

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.

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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.