The use of trazodone as a hypnotic: a critical review.
BACKGROUND
The last few years have seen a remarkable rise in the off-label use of trazodone for inducing sleep in nondepressed patients, to a degree that it is prescribed for this purpose as commonly as the leading hypnotic. In view of this widespread popularity, it seems prudent to review what is known of the safety and efficacy of trazodone when used in this context.


METHODS
A MEDLINE search of the literature published in English between 1975 and 2003 that included the keywords sleep, trazodone, Desyrel, depression, sleeping pill, and sedative-hypnotics was conducted.


RESULTS
From this review, it is concluded that there are very few data to suggest that trazodone improves sleep in patients without mood disorder, though it does increase total sleep in patients with major depressive disorder. There are virtually no dose-response data for trazodone vis-à-vis sleep and, similarly, no available data on tolerance to its possible hypnotic effects. Areas of concern with its use include reports of significant dropout rates and induction of arrhythmias, primarily in patients with histories of cardiac disease, as well as the development of priapism.


CONCLUSIONS
In summary, there are few data to support the use of trazodone in nondepressed subjects. When the risk-benefit ratio of trazodone is assessed, its side effect profile, which is much more significant than that of conventional hypnotics, should be considered.
Elan Pharmaceuticals, Inc., San Diego, CA 92130, USA. sjames@san.rr.com
Steven P
SP
James
Wallace B
WB
Mendelson
D000368:Aged; D001145:Arrhythmias, Cardiac / Q000139:chemically induced; D002986:Clinical Trials as Topic; D015897:Comorbidity; D003866:Depressive Disorder / Q000188:drug therapy / Q000453:epidemiology; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D011317:Priapism / Q000139:chemically induced; D007319:Sleep Initiation and Maintenance Disorders / Q000188:drug therapy / Q000453:epidemiology; D012893:Sleep Wake Disorders / Q000188:drug therapy* / Q000453:epidemiology; D019966:Substance-Related Disorders / Q000209:etiology; D014196:Trazodone / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome
D006993:Hypnotics and Sedatives; D014196:Trazodone