Section - Quick Takes

05. Is Trazodone Safe for Insomnia In Patients With Alcohol Use Disorder?

Published on November 28, 2025 Certification expiration date: November 28, 2028

David A. Gorelick, M.D., Ph.D., D.L.F.A.P.A., F.A.S.A.M.

Professor of Psychiatry - University of Maryland School of Medicine

Key Points

Up to 90% of individuals with alcohol use disorder (AUD) report insomnia. Certain FDA-approved AUD medications, such as naltrexone and disulfiram, may worsen sleep problems in some patients.
Trazodone 50–200 mg at bedtime can reduce insomnia in AUD, but may also decrease abstinent days or increase alcohol craving. Evidence for reduced abstinence is limited, yet prescribing should be cautious and well-informed.
CBT for insomnia may be the preferred first-line approach in AUD (weekly sessions for at least one month are suggested). If CBT is ineffective or unavailable, trazodone remains a reasonable option with appropriate monitoring.

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Insomnia in Alcohol Use Disorder

Sleep disturbance or insomnia is common among people who drink heavily or have alcohol use disorder (AUD). In self-report surveys, up to 90% of such individuals report having insomnia. This worsens their quality of life and may promote continued drinking as many people use alcohol to self-medicate insomnia.

Some FDA-approved medications for the treatment of AUD may themselves cause sleep problems. In particular, naltrexone and disulfiram worsened insomnia or caused somnolence in some clinical trials.

Sedative-Hypnotics: A Risky Choice

The clinical response might be prescribing a sedative-hypnotic such as a benzodiazepine or a zolpidem-type medication. However, these medications are rightly avoided by most clinicians because of their high abuse liability and potentially dangerous interaction with alcohol. Remember that both alcohol and benzodiazepines are potent CNS depressants.

Trazodone: A Popular Off-Label Option

Clinicians often resort to off-label prescribing a variety of non-sedative medications. The most popular

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Table of Contents

Learning Objectives:
After completing this activity, the learner will be able to:

Evaluate the efficacy and safety of ondansetron as an adjunctive treatment for residual negative symptoms in schizophrenia.
Analyze the potential role of lithium orotate supplementation in Alzheimer’s disease prevention and treatment based on preclinical evidence.
Apply clinical predictors and biological markers to guide medication selection in bipolar disorder.
Compare the effectiveness of dose optimization versus alternative treatment strategies (augmentation, switching, or psychotherapy) in patients with inadequate response to SSRI therapy for depression.
Select appropriate interventions for insomnia in patients with alcohol use disorder.

Original Release Date: November 28, 2025
Expiration Date: November 28, 2028

Experts: Oliver Freudenreich, M.D., Scott R. Beach, M.D., Kristin Raj, M.D., Paul Zarkowski, M.D. & David A. Gorelick, M.D., Ph.D., D.L.F.A.P.A., F.A.S.A.M.
Medical Editors: Flavio Guzmán, M.D. & Sebastián Malleza M.D.

Relevant Financial Disclosures:
Oliver Freudenreich declares the following interests:
– Karuna: Research grant to institution, advisory board
– Vida: Consultant
– American Psychiatric Association: Consultant
– Medscape: Speaker
– Wolters-Kluwer: Royalties, editor
– National Council for Wellbeing: Consultant

All the relevant financial relationships listed above have been mitigated by Medical Academy and the Psychopharmacology Institute.

None of the other faculty, planners, and reviewers for this educational activity has relevant financial relationships to disclose during the last 24 months with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

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