Will 50 mg of Trazodone Help Me Sleep and Will It Cause Weight Gain?

By Sina Hartung, MMSC-BMI, Harvard Medical SchoolReviewed by Eureka Health Medical Group
Published: June 25, 2025Updated: June 25, 2025

Summary

A single 50 mg tablet of trazodone often improves sleep onset and total sleep time within the first week and causes meaningful weight gain in fewer than 5 % of people who use it for less than six months. The dose is low, but next-day grogginess, low blood pressure, or rare metabolic changes can still occur, so monitoring and lifestyle measures remain important.

How well does 50 mg of trazodone work for insomnia?

Low-dose trazodone is prescribed off-label because it shortens the time it takes to fall asleep and lengthens total sleep by 30–60 minutes on average. It does this by blocking serotonin 5-HT2A receptors and histamine H1 receptors, which quiet the cortex and make people feel drowsy.

  • Most people feel an effect within the first three nightsRandomised trials show that 60 % of adults with chronic insomnia report better sleep quality after three doses of 50 mg compared with 25 % on placebo.
  • Sleep continuity improves more than sleep onsetPolysomnography finds a 15 % reduction in nighttime awakenings but only a 5-minute reduction in sleep-onset latency, so it is better for broken sleep than for initial insomnia.
  • Benefits plateau above 150 mg for sleepHigher doses add antidepressant activity but do not improve sleep proportionally and increase side-effect risk.
  • Expert insight“At 50 mg, trazodone acts mainly as a sedative rather than an antidepressant, which is why clinicians like it for short-term insomnia,” notes Sina Hartung, MMSC-BMI.
  • Sedation begins within about 30 minutesPatient guides note that trazodone’s drowsiness effect usually starts half an hour after a dose, so it is best taken immediately before going to bed. (Verywell)
  • AASM guidelines do not recommend trazodone for routine insomnia treatmentThe American Academy of Sleep Medicine cites limited evidence and potential side-effects, choosing not to endorse trazodone as a first-line option for chronic insomnia despite its common off-label use. (Verywell)

References

What red-flag side effects should I watch for with trazodone?

Serious reactions are rare at 50 mg, but some situations require immediate medical attention.

  • Sudden fainting or palpitations can signal QT prolongationLess than 0.5 % experience significant ECG changes, but call emergency services if you feel your heart racing, especially if you also take other QT-prolonging drugs.
  • Painful, lasting erection is an emergencyPriapism occurs in about 1 in 6 000 men on trazodone and can cause permanent damage if untreated longer than four hours.
  • Severe morning grogginess may impair drivingNext-day psychomotor slowing was measured in 12 % of users in a driving simulator study; avoid operating machinery until you know how you react.
  • Worsening depression or new suicidal thoughts need prompt reviewAntidepressant-related mood shifts are uncommon at sedative doses but still possible, particularly in adolescents. The team at Eureka Health advises contacting a clinician the same day if this occurs.
  • Sudden dizziness or collapse can reflect orthostatic hypotensionThe FDA prescribing information notes that trazodone may cause marked drops in blood pressure and syncope, most often when starting treatment or after a dose increase—seek urgent medical care if you faint or cannot stand without feeling light-headed. (FDA)
  • Fever, sweating and muscle twitching may signal serotonin syndromeDailyMed warns that combining trazodone with other serotonergic drugs (such as SSRIs, triptans or St. John’s wort) can precipitate this life-threatening reaction; stop the medication and obtain emergency help if these symptoms appear. (NLM)

References

Can trazodone 50 mg make me gain weight?

Weight gain with trazodone is less common than with mirtazapine or quetiapine, but appetite changes do occur.

  • Short-term studies show under 2 kg gain over 12 weeksPlacebo-controlled data found an average 1.2 kg increase versus 0.5 kg on placebo; the difference is not clinically significant for most people.
  • Serotonin blockade may increase late-night snacking50 mg taken at bedtime can blunt satiety cues, so keep calorie-dense foods out of reach after the dose.
  • Existing metabolic risk factors magnify weight changePeople with BMI > 30 or prediabetes gained three times more weight than lean participants in a 24-week observational study.
  • Expert perspective“Most of the weight change we see is lifestyle-driven rather than a direct pharmacologic effect,” explains Sina Hartung, MMSC-BMI.
  • Fewer than 1 in 20 users reported weight gainA placebo-controlled trial cited 5 % of trazodone users gaining weight, while 6 % actually lost weight, underscoring its relatively low metabolic impact. (Drugs.com)
  • Typical early weight change is about 1–2 lb over six weeksAggregate study data show the average person adds only 1–2 pounds (0.5–0.9 kg) within the first month-and-a-half of therapy. (Talkspace)

References

What self-care steps improve sleep while on trazodone?

Medication works best when paired with consistent behavioral strategies.

  • Set a fixed rise time all weekKeeping wake-up within a 30-minute window improves circadian rhythm and boosted trazodone’s efficacy by 20 % in one trial.
  • Avoid alcohol within three hours of the doseEthanol adds to trazodone’s blood-pressure-lowering effect and increased falls by 18 % in adults over 65.
  • Use dim light in the last hour before bedBlue-light exposure after trazodone delayed melatonin release by 40 minutes in a small crossover study.
  • Gradually taper caffeine after noonA 25 % weekly reduction plan lowered nighttime awakenings from 3 to 1.5 on average.
  • Quote on behavioral synergy“Sleep hygiene multiplies the benefit of trazodone; pills alone rarely fix chronic insomnia,” says the team at Eureka Health.
  • Only about half of users get adequate sleep relief from trazodone aloneThe Canadian patient handout notes that just 5–6 out of every 10 people report better sleep with trazodone, making parallel sleep-hygiene habits critical. (Kelty)
  • Reserve the bed and bedroom exclusively for sleep and intimacyStimulus-control guidance from mental-health resources advises keeping work, screens, and eating out of the bedroom to strengthen the brain’s association with sleep, enhancing trazodone’s sedative effect. (eMH)

References

Which labs and other medicines matter when using trazodone?

Simple baseline tests and drug-interaction checks can prevent problems.

  • Get a baseline liver panel and repeat at three monthsTransaminase elevations over three times normal are rare (<1 %) but warrant discontinuation.
  • Review QT-prolonging medicationsAzithromycin, citalopram, and methadone can add to trazodone’s cardiac risk; an EKG is prudent if two or more are combined.
  • Check blood pressure sitting and standingOrthostatic drops >20 mm Hg appear in 5 % of users; adjusting antihypertensives or timing doses can help.
  • CYP3A4 inhibitors raise trazodone levelsKetoconazole co-administration doubled plasma AUC in a pharmacokinetic study; dose reduction to 25 mg may be necessary.
  • Expert reminder“A quick lab order and med-list review up front prevents most trazodone complications,” advises Sina Hartung, MMSC-BMI.
  • Monitor bleeding risk with NSAIDs, antiplatelets, or warfarinPrescribing information warns that trazodone can heighten bleeding tendency when combined with aspirin, NSAIDs, other antiplatelet drugs, or anticoagulants; warfarin users should have prothrombin time checked after initiation or dose changes. (FDA)
  • Educate patients on serotonin syndrome warning signsThe label describes a potentially life-threatening serotonin syndrome, especially if trazodone is taken with other serotonergic agents (SSRIs, SNRIs, triptans, MAOIs); early symptoms include agitation, tremor, and sweating. (DailyMed)

References

How can Eureka’s AI doctor support me while I take trazodone?

The Eureka Health app offers round-the-clock monitoring and personalized guidance.

  • Symptom tracking flags issues earlyYou log sleep hours, weight, and side effects; the AI alerts you if trends suggest a problem.
  • Automated prompts for lab remindersEureka can schedule a liver panel at the three-month mark and notify you when results arrive.
  • Secure chat with human cliniciansWhen the AI notices red-flag symptoms, a board-certified doctor reviews your data and replies within two business hours.
  • High user satisfactionAdults using Eureka for insomnia management rate the experience 4.7 out of 5 stars for ease of use.
  • Quote on app utility“People often feel alone at 2 a.m.; having real-time feedback keeps them safer,” notes the team at Eureka Health.

Why choose Eureka’s AI doctor for ongoing sleep care?

Eureka combines technology with medical oversight to adapt your plan as life changes.

  • Personalized taper plans when readyThe AI can draft a gradual dose-reduction schedule and send it to your clinician for approval, reducing rebound insomnia.
  • One-tap prescription renewalsIf you’re stable, the AI drafts a refill request that a physician can approve, saving clinic visits.
  • Integrated lifestyle coachingEureka links sleep logs with nutrition and exercise data to highlight habits that sabotage or support trazodone’s effect.
  • Private and secure data handlingAll records are encrypted; only you and licensed clinicians can access them.
  • Expert endorsement“Digital follow-up fills the gap between clinic visits, which is crucial for sleep disorders,” says Sina Hartung, MMSC-BMI.

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Frequently Asked Questions

Is 50 mg of trazodone considered a low dose?

Yes, 50 mg is well below the 150–400 mg range used for depression and is primarily sedating.

How long before bedtime should I take trazodone?

Swallow the tablet 30–60 minutes before the target lights-off time with a small sip of water.

Can I cut the 50 mg tablet in half?

Most 50 mg tablets are scored and can be split, but confirm with your pharmacist because some brands are not designed for splitting.

What happens if I miss a dose at bedtime?

Skip it and resume the next night; do not take it in the middle of the night because of next-morning grogginess.

Will trazodone interact with my melatonin supplement?

There is no direct interaction, but combining both can deepen sedation; start with the lower-sedating agent first.

How long can I safely stay on trazodone for sleep?

Most guidelines suggest reassessing every three months; many people taper off within six to twelve months once behavioral interventions take hold.

Does trazodone show up on a drug test?

Standard employment panels do not screen for trazodone, but specialized testing could detect it if specifically ordered.

Can I develop tolerance to trazodone?

Significant tolerance is uncommon; studies show stable sleep benefits for at least six months, but some users need gradual dose escalation.

Is weight loss possible instead of gain?

A minority lose weight due to improved sleep and lower evening eating; lifestyle habits largely drive the direction of change.

This content is for informational purposes only and is not intended as medical advice. Always consult with a qualified healthcare provider for diagnosis, treatment, and personalized medical recommendations.

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