Is it safe to take buspirone and trazodone together?

In this article:

• BuSpar vs. buspirone
• Can you take trazodone and buspirone together?
• Trazodone and buspirone interactions and side effects
• How to take buspirone with trazodone
• Buspirone and trazodone comparison
• Bottom line

In this article

• BuSpar vs. buspirone
• Can you take trazodone and buspirone together?
• Trazodone and buspirone interactions and side effects
• How to take buspirone with trazodone
• Buspirone and trazodone comparison
• Bottom line

Between the feelings of worry, irritability, and impending doom, anxiety can make it seem like the world is closing in around you. Sleepless nights only make matters worse. Prescription medications like buspirone and trazodone help some people with their symptoms. Buspirone is an anti-anxiety (anxiolytic) drug that’s prescribed specifically for anxiety symptoms, while trazodone (brand name: Desyrel) is an antidepressant medication prescribed for insomnia, depression, and anxiety.

Some people who have both anxiety and insomnia or depression may wonder whether they can take the two drugs together for their symptoms. However, not every patient should take buspirone and trazodone together. Here are all the details on potential interactions, side effects, and other precautions you need to know.

BuSpar vs. buspirone

BuSpar was a former brand-name version of buspirone, but the BuSpar brand was discontinued in 2009, so it’s no longer sold under that label. The Food and Drug Administration (FDA) has made it clear that this discontinuation was not because of concerns with BuSpar’s safety or effectiveness. Rather, it was taken off the market after the generic version (buspirone) became more easily accessible.

The FDA requires generic medications to have the same active ingredient, strength, dosage form, efficacy, and route of administration as their reference drugs, so buspirone is essentially the same as BuSpar.

Can you take trazodone and buspirone together?

It’s not recommended to take trazodone with buspirone, but that doesn’t mean it isn’t done. “The answer always is ‘it depends,’ and this will vary based on the unique circumstances of each patient,” says psychiatrist Cooper Stone, DO. “However, if the patient is somebody who is struggling with anxiety and insomnia, this is a medication regimen that could make sense for the right person.”

Dr. Stone emphasizes that the combination of trazodone and buspirone isn’t right for every patient. That’s because when the two medications are taken routinely together there are potential serious interactions. “In most cases, people who take trazodone and buspirone together will tolerate this combination just fine and reap the benefits of both,” he explains. “However, it is very important to know that both medications affect serotonin levels and can precipitate a very serious condition known as serotonin syndrome.”

Buspirone and trazodone both affect the brain’s levels of serotonin, a neurotransmitter that helps control mood regulation, sleep, and other bodily functions. Serotonin is known as the body’s “feel-good chemical,” but having too much of it can cause serious issues. In severe cases, serotonin syndrome is life-threatening.

This combination might also cause abnormal liver function, according to David Hendricks, MD, assistant medical director at Mountainside. “Especially for those struggling with alcohol abuse, if they take these medications, their liver enzymes can be affected by these medications,” he says. “Additionally, taking buspirone and trazodone together can disrupt the blood clotting process in the liver and pose a bleeding risk.”

While some patients can take trazodone and buspirone together, it should only be under a healthcare provider’s direction and liver function monitoring. “Before a person takes both, it’s recommended to do blood work to check for healthy platelet count or abnormalities,” Dr. Hendricks says. “I’d also conduct liver function tests and check for signs of inability to clot. If you lack blood clotting enzymes, you can be at risk of bleeding if you take these medications together.

Trazodone and buspirone interactions and side effects

Serotonin syndrome and liver issues are the most potentially dangerous drug interactions between buspirone and trazodone—and the ones that are most likely to deter healthcare providers from prescribing them for certain patients. Serotonin syndrome can cause symptoms like agitation, fast heart rate, high blood pressure, hallucinations, fever, loss of coordination, nausea, vomiting, sweating, shivering, and diarrhea. In severe cases, it can also cause delirium, seizures, and fainting.

However, each drug also has various adverse effects that may manifest during treatment. The most common trazodone side effects are drowsiness, dizziness, lightheadedness, dry mouth, nervousness, and blurred vision. Buspirone’s most common side effects are dizziness, nervousness, nausea, headache, and lightheadedness.

There’s a chance that taking these two together can compound their side effects, even causing excessive drowsiness or central nervous system (CNS) depression—a medical condition that can lead to confusion, dizziness, impaired coordination, and other symptoms. Consult a healthcare provider if you’re concerned with the serious side effects of either drug.

How to take buspirone with trazodone

Considering their interactions, in cases when they’re prescribed together, it’s crucial to follow the healthcare provider’s dosages and instructions exactly.

Healthcare providers may stagger the introduction of trazodone and buspirone to ease the patient in. “It is generally best not to start them both at the same time. This way, if the patient were to experience a side effect from one of the medications, it will be easier to determine the cause,” Dr. Stone says. “Therefore, it is best to wait one to two weeks before introducing a new medication.”

Additionally, patients should never increase their dosage without first consulting a healthcare provider. Per Dr. Stone, the risk of serotonin syndrome “increases if the doses of these medications are increased too quickly, are prescribed at high doses, or are being taken with other medications that also act on serotonin.”

With that in mind, it’s also important to tell your healthcare provider about other medications and supplements you’re taking and avoid taking this combination—or either drug individually—with certain medications. Trazodone and buspirone may interact with:

• Selective serotonin reuptake inhibitors (SSRIs) like Prozac (fluoxetine), Zoloft (sertraline), and Lexapro (escitalopram oxalate)
• Serotonin-norepinephrine reuptake inhibitors (SNRIs) like Cymbalta (duloxetine)
• Monoamine oxidase inhibitors (MAOIs) like selegiline
• Tricyclic antidepressants like amitriptyline
• Opioid analgesics like oxycodone or tramadol
• Drugs that affect heart rhythm, like Nexterone (amiodarone)
• Drugs that affect blood clotting, like Coumadin (warfarin)
• Antipsychotic medications
• Over-the-counter supplements like L-Tryptophan and St. John’s wort

There may be additional drugs that interact with buspirone and trazodone, so even if you’re taking something that’s not on this list, you should still inform your healthcare provider.

The maximum trazodone dosage is 400–600 mg per day, although how it’s dosed depends on the condition it’s treating. Buspirone’s maximum dosage is 60 mg per day, but similarly, it depends on whether you’re taking it for anxiety or depression.

Buspirone and trazodone comparison

Both drugs can be prescribed for anxiety and depression, but there are some significant differences between them. For example, trazodone is a serotonin receptor antagonist and reuptake inhibitor, while buspirone is an anxiolytic, so they have different mechanisms of action. Trazodone is also approved to treat insomnia, while buspirone is more focused on anxiety. “In my experience, trazodone is not too effective against anxiety and rather prescribed for people who have insomnia or trouble sleeping,” Dr. Hendricks says. “Buspirone is used for anti-anxiety. There are very few instances where you would swap one medication for the other.”

Additionally, trazodone carries a black box warning from the FDA that it may cause suicidal thoughts and behaviors, but buspirone does not. Patients should tell their healthcare provider if they have a history of liver, kidney, or heart problems before taking either drug. And it’s unclear whether either one can affect unborn or newborn babies, so pregnant or nursing mothers may want to avoid them.

Price-wise, both are generic drugs, so they’re both fairly affordable compared to brand-name alternatives, and both are often covered by insurance—depending on the specific plan and the condition they’re treating. Of course, your healthcare provider will make the final call on which drug is best for your specific condition, so consult them before taking either one.

Buspirone vs. trazodone: Comparison chart
	Buspirone	Trazodone
Drug class	Anxiolytic	Serotonin receptor antagonist and reuptake inhibitor
Standard dosage and forms	Anxiety: 20–30 mg per day taken in two or three divided doses Depression (off-label): 30–60 mg per day taken in two or three divided doses	Depression: 50–100 mg two to three times daily Anxiety: 75–300 mg twice daily Insomnia: 25–50 mg tablets at night before bedtime
Risks and restrictions to consider	Can interact with drugs that affect serotonin  May cause kidney or liver problems for people with pre-existing issues  Avoid if pregnant or breastfeeding	May cause suicidal thoughts   Can interact with drugs that affect serotonin, bleeding, and heart rhythm May cause liver issues. Avoid if pregnant or breastfeeding
Side effects	Dizziness Nervousness Nausea  Headache Lightheadedness	Drowsiness  Dizziness/lightheadedness Dry mouth Nervousness Blurred vision
Average cost without insurance	$42 for 60, 5 mg tablets	$35 for 30, 50 mg tablets
SingleCare cost	Get coupon	Get coupon
Learn more	More buspirone details	More trazodone details

 

Bottom line

Trazodone and buspirone both treat anxiety and depression, but it’s not always safe to take them together. Some people can, as long as they follow their healthcare provider’s instructions exactly, but others might be at risk of developing serotonin syndrome, liver problems, or other serious side effects. Always talk to a healthcare professional before making decisions regarding medication, dosage, or other medical circumstances.