Is it safe to take clonazepam and trazodone together?

In this article:

• Can you take trazodone and clonazepam together?
• Warnings and side effects of taking trazodone with clonazepam
• How to take clonazepam with trazodone
• Is clonazepam or trazodone better?
• Clonazepam vs. trazodone: Comparison chart

In this article

• Can you take trazodone and clonazepam together?
• Warnings and side effects of taking trazodone with clonazepam
• How to take clonazepam with trazodone
• Is clonazepam or trazodone better?
• Clonazepam vs. trazodone: Comparison chart

Feeling anxious and having trouble sleeping can hurt one’s mental health. Sometimes, your healthcare provider may prescribe certain medications to help with these issues. Two common drugs prescribed are clonazepam and trazodone. 

Clonazepam is a generic prescription medication used to treat seizures or panic disorder. It belongs to a class of drugs called benzodiazepines. With its pronounced sedative effects, healthcare providers frequently prescribe clonazepam for off-label, unapproved uses such as anxiety, insomnia, and other medical conditions. In the United States, both clonazepam and trazodone are available as brand-name drugs with a generic option. Klonopin is the brand name for clonazepam.

Trazodone is a prescription medication approved by the Food and Drug Administration (FDA) to treat depression, a common mental health condition. Trazodone is a generic prescription that healthcare providers may often prescribe off-label to treat anxiety if other treatments don’t work. Brand-name versions of trazodone, including Desyrel, Desyrel Dividose, Trialodine, and Oleptro, have all been discontinued in the United States.

Healthcare providers may prescribe both clonazepam and trazodone for insomnia even though they’re FDA approved for use as sleep aids. But there are important things to consider, even if they’re prescribed under the guidance of a healthcare provider. 

Can you take trazodone and clonazepam together?

Yes, in some cases, you can take clonazepam and trazodone together. But it’s not something you should do without talking to your healthcare provider first. Clonazepam can help reduce anxiety, while trazodone can improve sleep, so healthcare providers may prescribe both drugs together for people who have severe anxiety along with sleep problems. 

Warnings and side effects of taking trazodone with clonazepam

Combining clonazepam and trazodone can increase side effects like dizziness, drowsiness, confusion, and difficulty concentrating. Older adults might experience impairments in thinking, judgment, and motor coordination while taking both drugs. Avoid alcohol and activities requiring mental alertness, such as driving, until you know how these medications affect you. Always inform your healthcare provider about any prescription and over-the-counter (OTC) medications, natural supplements, vitamins, and herbs you’re taking. Don’t stop using any medications without consulting your healthcare provider first. 

A 2022 study looked at whether treating sleep disorders with benzodiazepines, compared to other medications like trazodone, hydroxyzine, and Z-drugs (zolpidem, zaleplon, eszopiclone), increases the risk of drug overdose in young people. The study found that young people using benzodiazepines had a higher risk of overdose compared to those using other sleep medications. This highlights the need for caution when prescribing benzodiazepines to young people.

Benzodiazepines can be habit-forming and carry risks of abuse, misuse, and addiction, which can lead to respiratory depression, overdose, or death. As a result, benzodiazepines are classified as controlled substances by the Drug Enforcement Administration (DEA)—specifically as Schedule IV drugs, which have a low risk of dependency and abuse but more risk than Schedule V drugs.

How to take clonazepam with trazodone

It’s important to take medications like trazodone and clonazepam together only if your healthcare provider approves. They will decide whether the benefits outweigh the risks, considering factors like:

• Your age and overall health
• Other medications or supplements you’re using
• How severe your symptoms are
• Your risk for side effects

If your healthcare provider decides it’s okay for you to take both medications, they’ll give you specific instructions. Here are some general tips:

1. Take each medication exactly as prescribed. Don’t change the dose or timing without talking to your healthcare provider first, and do not stop using either of the medications without first talking to your healthcare provider.
2. Usually, you’d take clonazepam earlier in the day for anxiety and trazodone closer to bedtime for sleep. But always follow your healthcare provider’s instructions.
3. Your healthcare provider may start with low doses of each medication and slowly increase the doses if needed.
4. Be aware and careful with activities like driving or operating machinery, especially when you first start taking these drugs together. They can make you very sleepy and slow down your reaction time.

The American Academy of Sleep Medicine’s practice guidelines recommend the use of low-dose trazodone as a second-line treatment option for secondary insomnia when treating concurrent depression or anxiety. The drug is a third-line treatment option when other first- and second-line treatment options (e.g., melatonin agonists and benzodiazepine agonists such as zolpidem and temazepam) are ineffective for treating chronic primary insomnia.

Is clonazepam or trazodone better?

Clonazepam and trazodone are different types of medications, even though they might be used to treat some of the same problems. Which one is “better” depends on what it’s used for and how a person’s body responds.

As a benzodiazepine, Klonopin (clonazepam) works by increasing the effectiveness of a chemical messenger in the brain called gamma-aminobutyric acid (GABA), which reduces the excitability of neurons, leading to a calming effect. Clonazepam is also used off-label (without FDA approval) to treat other conditions such as anxiety, restless leg syndrome, sleepwalking, and Tourette syndrome. Clonazepam is available as an oral tablet and an orally disintegrating tablet, which can be helpful for people who have difficulty swallowing traditional oral tablets or capsules. 

Trazodone is a serotonin antagonist and reuptake inhibitor (SARI) that works by increasing serotonin levels in the brain. This causes trazodone to have a sedative effect, causing sleepiness. For this reason, it is sometimes prescribed off-label for conditions such as insomnia, anxiety, and fibromyalgia. Although the American Academy of Sleep Medicine doesn’t recommend trazodone as a first-choice medication for insomnia, healthcare professionals may prescribe it because it causes fewer side effects than other medications for sleep issues.

Several studies have compared these drugs for specific uses:

1. Sleep disorders: In a systematic review, trazodone was more effective than benzodiazepines (the class of drugs that includes clonazepam) for treating insomnia in patients with depression. Trazodone improved sleep quality with fewer side effects.
2. Anxiety disorders: Research published in Clinical Psychopharmacology and Neuroscience showed that clonazepam was more effective than placebo in treating generalized anxiety disorder. It worked quickly and was well-tolerated by patients. While trazodone can help with anxiety, especially when it’s related to depression, it’s not typically a first-choice treatment for anxiety disorders.
3. Parkinson’s disease: A 2022 study evaluated trazodone, clonazepam, and melatonin safety and efficacy in improving sleep quality in patients with Parkinson’s disease. After four weeks, all treatments led to better sleep. Still, melatonin was more effective at reducing symptoms of REM sleep behavior disorder, while trazodone improved daytime sleepiness more than clonazepam. 

When deciding between clonazepam and trazodone, healthcare providers consider several factors:

• The main symptoms being treated (anxiety, depression, sleep problems, etc.)
• How quickly the medication needs to work
• Potential side effects and how they might affect the patient
• Risk of dependence (which is higher with clonazepam)
• Other health conditions the patient might have
• Other medications the patient is taking

For example, if someone has both depression and insomnia, a healthcare provider might choose trazodone because it can help with both issues. But if someone has severe panic attacks and needs quick relief, clonazepam might be a better choice.

Bottom line

Remember, the choice between clonazepam and trazodone (or using both) should always be

made by a healthcare provider who knows your complete medical history. While it’s possible to take clonazepam and trazodone together in some cases, it’s crucial to do so only under a healthcare provider’s guidance. These medications can interact with each other and with other drugs you might be taking. Always follow your healthcare provider’s instructions carefully, and only change your dosage after talking to them first.