Can You Take Trazodone With Alcohol? Know the Risks

It’s 3 a.m. — again. You’ve tried counting sheep, distracting yourself with another episode of a podcast, you’ve even tried the “warm milk with honey” and “count backwards from 100” methods. You’ve tried it all, and yet, night after night, you find yourself unable to fall asleep and wake up every morning groggier than ever, still having to brush your teeth, throw on an outfit, grab a caffeinated drink, and face the day.

Then, your doctor suggests trazodone and — hallelujah! — you finally find relief. Finally, you can doze off and actually stay asleep. But then you think, what about this weekend? You’re planning to go out and have a drink with friends, but still want to catch your z’s tonight. Can you take trazodone with alcohol? Or do alcohol and trazodone not play well together? 

That evening, when you return, instead of listening to your podcast you start anxiously searching the net for “trazodone and alcohol” and end up googling things like “trazodone and alcohol death.” Yikes — this time you truly do scare yourself out of sleep altogether.

Before that happens again, let’s dive into the subject of trazodone and alcohol interactions without the doom and gloom — and see why the two don’t really mix well. Knowledge is power!

Trazodone: Tales of an Antidepressant

Trazodone has been around since 1981 and is — in spite of its current popularity as an insomnia medication — an antidepressant. It works by helping our brain restore levels of serotonin, the mood-regulating neurochemical involved in brain pathways responsible for making us feel happy and secure. Low levels of serotonin are linked to depression, which is why this particular pathway is the target of many depression therapies.

Trazodone in particular belongs to the “serotonin-antagonist-and-reuptake-inhibitor” group of medications. What does this mouthful of a name really mean? Like its popular SSRI cousins, it helps boost serotonin levels in the brain by preventing it from getting cleared out of synapses too quickly while also going after “serotonin antagonists” that work to block this particular neurotransmitter.

A Mood-Managing Multitasker

While it may have started its “career” as an antidepressant, trazodone quickly became the master-of-all-trades and is now prescribed for a number of different conditions. A CNS Spectrum article titled “Mechanism of Action of Trazodone: A Multifunctional Drug” explains that while at higher doses trazodone mostly affects serotonin, at lower doses it blocks histamine receptors and adrenergic receptors. As a result, it also has “hypnotic” properties at low doses, making it suitable for treating conditions that call for calming the nervous system.

• Sleep disorders. On those sleepless nights, trazodone helps improve sleep patterns and is now “one of the most commonly used prescription medications for insomnia.” As a matter of fact, its use as a sleep aid is now much more common than its original purpose as an antidepressant.
• Anxiety. In addition to being used to treat depression, trazodone has also worked as an antianxiety aid for some. When prescribed for this purpose, however, it’s usually taken in lower amounts.
• Chronic pain. Trazodone also has a place in the world of pain management. Some studies have shown that it may reduce symptoms of fibromyalgia due to its effects on sleep and serotonin modulation. It can also be helpful in treating neuropathic pain.

Trazodone: The Side Story

Like any other medicine, trazodone comes with some side effects. Most are fairly mild.

• Sedation (of course!)
• Intestinal discomfort, such as nausea or diarrhea
• Dry mouth or a bad taste in mouth
• Dizziness
• Blurred vision

Occasionally, things get a bit more serious.

• Arrhythmia
• Seizures
• Fainting
• Cognitive impairment
• Motor impairment
• Occasionally, trazodone can trigger manic episodes in people with bipolar disorder

While some of these symptoms sound scary and others are merely unpleasant, remember that serious side effects are rare. Doctors prescribe trazodone because they believe the benefits will be worth any potential side effects.

Steering Clear of Serotonin Syndrome

Serotonin syndrome is rare, but it’s a possibility with any drug that tweaks our serotonin levels, especially if we’ve taken a drug from the MAO inhibitor family in the last 14 days (some examples include isocarboxazid, linezolid, methylene blue injection, phenelzine, and tranylcypromine, but there are many others). If your doctor is aware of all of your medications, they will give strict directions about taking trazodone to avoid this serious complication. Always check with your doctor!

Serotonin syndrome is pretty much exactly what it sounds like — our system gets overloaded with serotonin, leading to some pretty unsavory (and even dangerous) results. Here are the symptoms to watch out for:

• Mild: Shivering, diarrhea, headache, agitation, and rapid heart rate
• Moderate: Confusion, muscle rigidity, fever, and abnormal eye movements
• Severe: High fever, seizures, irregular heartbeat, and unconsciousness

Can You Drink on Trazodone?

In general, mixing antidepressants and alcohol isn’t a good idea. (For more information, check out our blog Alcohol and Antidepressants: A Dangerous Combo.) But why are trazodone and alcohol in particular a risky pairing?

• We can become too sedated. Both trazodone and alcohol can depress the nervous system’s functions, leading to extreme drowsiness or dizziness. There’s even potential for respiratory distress or unconsciousness in severe cases.
• Our depression can get worse. If we’re taking trazodone for depression or anxiety, there’s also an increased risk of depression or anxiety symptoms worsening.
• We can end up with more intense side effects. Alcohol can also interfere with the metabolism of trazodone, potentially increasing its plasma concentration and exacerbating side effects.
• We’re at risk of dependency. The interaction between the two substances increases risk of dependency on either (or both) of the medications — we could find ourselves grappling with a more intense “need” for both.
• We risk having a trazodone and alcohol overdose. Alcohol can increase the concentration of trazodone in our blood, raising the risk of an overdose, which could be life-threatening.

How Many Drinks Can I Have on Trazodone? (Can I Have One?)

Given the downer effect of both substances and the heightened risk of overdose, the safest answer is really zero. It’s hard to say when we cross the line into danger, since that depends on many factors, including age, metabolism, general health, and the presence of any other substances in our system. That said, it’s a risk that’s truly not worth taking, especially given the curveball of increased concentration of trazodone in our system after drinking. Best case scenario? We’ll get really sleepy and might wake up with a killer hangover. But why test it?

Trazodone for Alcohol Withdrawal: Smoothing the Turbulence

While trazodone might not play well with alcohol, it’s a whole different story when it comes to alcohol withdrawal. In fact, it’s often a go-to medication doctors prescribe to relieve insomnia triggered when we suddenly stop drinking. 

Why is insomnia an issue in withdrawal? Once again, the answer has to do with the brain. The depressant effects of alcohol stem from the effects it has on two neurotransmitters — GABA (an inhibitory neurotransmitter) and glutamate (its excitatory counterpart). By boosting one and suppressing the other, alcohol puts a damper on the whole system, making us feel drowsy. 

Over time, the body gets used to the “new normal” and adjusts brain chemistry accordingly. Suddenly removing alcohol throws a wrench in the system, causing us to feel agitated and unable to sleep.

This is where trazodone comes to the rescue! By acting as a sedative, it can ease the transition, letting us catch some much-needed z’s as we readjust and get ready to take the important (and exciting!) step into the world beyond booze.

A Note of Caution

While administering trazodone to treat withdrawal is frequently the method used in many inpatient facilities (as well as on an outpatient basis), some in the medical community aren’t so sure it’s a great idea. A study in Alcohol Clinical and Experimental Research that looked at short- and long-term success in staying booze-free found that while trazodone helped with the initial withdrawal stage, it reduced the likelihood of staying sober over time. 

The researchers followed 88 participants who received trazodone and 85 who were given a placebo and found that “the trazodone group experienced less improvement in the proportion of days abstinent during administration of study medication … and an increase in the number of drinks per drinking day on cessation of the study.” And sleep quality? While trazodone did lead to an improvement, it was business as usual when it was stopped: both experimental groups were in the same boat as far as sleep patterns were concerned.

Alcohol and Sleep: A Hidden Culprit 

A final point to consider is that if we usually take trazodone for sleep — and if alcohol is a frequent presence in our life — alcohol could be partially to blame for our sleep problems in the first place.

Though it makes us initially drowsy, alcohol is a notorious sleep disruptor. 

• It robs us of REM sleep. Alcohol sends us right into deep sleep, bypassing the crucial Rapid Eye Movement (REM) phase, which is known to be the most restorative.
• It keeps us running to the bathroom throughout the night. Alcohol is dehydrating as it causes the kidneys to expel extra water. The unfortunate result is that once the floodgates are open, they often stay open well into the night, waking us up and causing sleep disruptions.
• It disrupts our overall “sleep architecture,” The result? Less restful slumber. We might wake up having logged 8 hours of sleep (or more) but feel like we’re still running on empty.

Tips for the Journey 

And now, here’s some advice for staying safe when it comes to alcohol and trazodone.

• Avoid the mix. To steer clear of the excessive sedation that can result from mixing trazodone and booze, don’t combine the two. Always talk to your doctor if you have concerns, and don’t hesitate to ask for help if you end up accidentally combining your meds with alcohol (or if you find it difficult to stop drinking). There’s no judgment, and there’s help available (including Reframe)!
• Try other sleeping aids. If you’re taking trazodone for sleep, opt for a different way to help you get your rest if you know that you’ll be drinking. While most medications don’t pair well with booze, practicing good sleep hygiene, taking magnesium supplements, and drinking chamomile or lavender tea works wonders for some!
• Consider cutting back. If you’re finding that alcohol isn’t “mixing well” with other aspects of your life (not just with trazodone), consider cutting back. The sober-curious movement is stronger than ever, and there are so many fun alternatives that make an alcohol-free lifestyle worth exploring.

Summing Up

All in all, alcohol doesn’t play nice with many medications, and trazodone is one of them. So whether you’re taking it for its mood-stabilizing properties, as an insomnia aid, or for a different reason altogether, it’s best to stay away from alcohol in the meantime. Reframe is here to support you on your journey, providing you with the latest neuroscience-backed tips on cutting back or quitting for good, if you decide that’s right for you! In the meantime, stay safe and give your body and mind the attention and care it truly deserves.