Can you take trazodone and lorazepam together?

In this article:

• Can you take trazodone and lorazepam together?
• Is trazodone or lorazepam better?
• Trazodone vs. lorazepam: Comparison chart

In this article

• Can you take trazodone and lorazepam together?
• Is trazodone or lorazepam better?
• Trazodone vs. lorazepam: Comparison chart

Sleep and mental health are deeply connected. In fact, insomnia can elevate the risk of anxiety or worsen its symptoms. Sometimes, treating one improves the other. In other cases, insomnia and anxiety or depression require different treatments.

Trazodone hydrochloride is an antidepressant known to cause drowsiness. Although it is approved by the Food and Drug Administration (FDA) for major depressive disorder (also known as clinical depression) in adults, it is sometimes prescribed off-label to treat anxiety.  

Lorazepam (generic Ativan) is a fast-acting drug that is FDA approved for anxiety disorders, anxiety-induced insomnia, and long-lasting seizures. It is also prescribed off-label as a sleep aid. 

If you or someone in your care has insomnia along with anxiety or depression, you might wonder whether it is okay to take trazodone and lorazepam together. The answer depends on the circumstances. Below, our experts unpack safety, side effects, and other considerations to know before combining trazodone and lorazepam.

Can you take trazodone and lorazepam together?

You can take trazodone and lorazepam together, but there are risks, and it ultimately depends on various factors that should be considered on a case-by-case basis.

Trazodone and lorazepam are sometimes prescribed to be taken on the same day but not at the same time. For instance, Sid Khurana, MD, psychiatrist and cofounder of Nevada Mental Health, says someone might take a nightly dose of trazodone for chronic insomnia while taking lorazepam during the day if and when a panic attack strikes. Simultaneous dosing is not recommended “because we don’t want someone’s respiratory system to get too depressed,” he says.

Alex Dimitriu, MD, a double-board-certified psychiatrist, sleep medicine physician, and founder of Menlo Park Psychiatry & Sleep Medicine, says that while there are no known interactions between lorazepam and trazodone, he considers it ideal to take one or the other—not both. He also says trazodone is usually preferred because it is “gentler” and safer for long-term use.

Still, trazodone and lorazepam are prescribed together when necessary—though usually during a short-term period of acute treatment. “We use the combination of trazodone and lorazepam on a daily basis,” says Renee Solomon, a clinical psychologist and the clinical director and CEO of Forward Recovery, an addiction rehabilitation center in Los Angeles. 

“When clients are coming in detoxing from drugs and alcohol, they are often prescribed lorazepam to deal with the dangers and side effects of withdrawal. Many of them have issues sleeping, and we utilize the trazodone to help them sleep at night.”

RELATED: Trazodone for sleep: What you need to know

Both trazodone and lorazepam can suppress the central nervous system (CNS), so both Drs. Khurana and Soloman warn that combining them can cause severe drowsiness. Sleepiness, combined with lorazepam’s potential for respiratory suppression, can be dangerous.  

Bottom line: Anyone who wants to take trazodone and lorazepam together should speak with their healthcare provider first. It is critical to get medical advice before combining medications, as combining drugs increases the risk of interactions, side effects, and other adverse events. 

Is trazodone or lorazepam better?

Trazodone and lorazepam are very different medications. Which one is better depends on an individual’s symptoms and medical conditions.

Research has repeatedly demonstrated traxodone’s effectiveness as a sleep aid. Lorazepam has also been proven effective for sleep trouble—anxiety-induced insomnia, specifically. But beyond both helping treat sleep difficulties, these medications are not similar, which explains the lack of head-to-head comparisons in scientific research.

Drug class

Trazodone and lorazepam belong to two different drug classes. Trazodone is an antidepressant that is a serotonin antagonist and a serotonin reuptake inhibitor. Antidepressants like trazodone are considered generally safe for long-term use. 

Lorazepam is a benzodiazepine that can be administered by mouth or injection. Colloquially known as a “benzo,” lorazepam is a controlled substance with a risk of misuse and dependence.

Effectiveness for mental health conditions

Trazodone and lorazepam do not treat the same mental health conditions. Which drug is best depends on the condition being treated.

Trazodone is FDA approved and proven effective for depression. However, it is most widely used for the treatment of insomnia. Other less common off-label uses include the following:

• Anxiety
• Alzheimer’s disease
• Substance misuse
• Bulimia
• Post-traumatic stress disorder (PTSD)

Lorazepam is FDA approved for anxiety, anxiety-related depression, and long-lasting seizures. It is a fast-acting anti-anxiety medication that is favored in in-patient psychiatric settings. Off-label uses include:

• Insomnia
• Nausea and vomiting from cancer treatments
• Agitation caused by alcohol withdrawal
• Panic disorder

Effectiveness for sleep issues

“Doctors often try to use trazodone first as it is a gentler agent, less habit forming, and not a controlled substance,” Dr. Dimitriu says. “Because trazodone is gentler, it may take longer to work and [may] not feel quite as strong as lorazepam,” says Dr. Dimitriu. “However, trazodone is much better in the long-term and can actually improve sleep architecture, which is the opposite effect of lorazepam.”

Ultimately, even though lorazepam might help someone fall asleep more quickly, especially if sleep troubles are linked to anxiety, it’s not the best or safest long-term treatment for insomnia or sleep issues. Therefore, trazodone is better for long-term treatment of insomnia.

Common side effects

The most common side effect of trazodone is drowsiness. Other common side effects of trazodone include dry mouth, lightheadedness, and headaches. “Trazodone can also make some people dizzy, and it can give them nausea and potentially [cause] vomiting,” Dr. Khurana says. Priapism, a prolonged and painful erection, is also a rare but serious side effect of trazodone in men.

RELATED: What are the side effects of trazodone for older adults?

Common side effects of lorazepam also include dizziness and drowsiness. But lorazepam side effects also include muscle weakness. Serious side effects include respiratory depression and memory problems.

Risks and restrictions

The drug labels for both trazodone and lorazepam include disclaimers about risks, restrictions, and possible drug interactions. It is essential to review this information before taking these medications. It is also important to tell your healthcare provider about other medicines (including over-the-counter drugs and supplements) and health conditions (including pregnancy) before taking trazodone, lorazepam, or both.

One of the most critical warnings associated with trazodone is an increased risk of suicidal thinking. Trazodone has a boxed warning (also called a black box warning) about the increased risk of suicidal thinking and behavior in children, adolescents, and young adults taking antidepressants for major depressive disorder (MDD) and other psychiatric disorders. There is also a risk of serotonin syndrome, which can occur when serotonin levels get dangerously high. If you experience extreme mood swings and changes in mental health, report the symptoms to your healthcare provider immediately. 

Lorazepam has a boxed warning about an increased risk of serious or life-threatening breathing problems and sedation. Dr. Khurana warns that lorazepam should never be mixed with alcohol as there is a risk of “shutting down your respiratory system.” The boxed warning also indicates that there is a serious risk of abuse, misuse, and dependency when taking benzodiazepines like lorazepam.

Cost

The out-of-pocket costs of trazodone and lorazepam depend on the dosage, insurance coverage, and preferred pharmacy. The retail cost of a daily dose of trazodone is lower than lorazepam, but actual costs will vary.

Without insurance, trazodone costs about $34 for 30, 50 mg tablets. When used for depression, trazodone is dosed two or three times daily, so the average out-of-pocket cost could be $102 per month for some patients. When taken off-label for insomnia, trazodone is only dosed once per day.

Without insurance, lorazepam costs about $28 for 30 0.5 mg tablets. There is a wide range of doses, but at 3 mg daily, the monthly retail cost is about $112. When taken off-label for insomnia, lorazepam has a similar dose and monthly cost.

Trazodone vs. lorazepam: Comparison chart
	Trazodone	Lorazepam
Drug class	Antidepressant	Benzodiazepine
Form(s)	Tablet	Oral tablet, oral concentrate, injection
Uses	FDA-approved:  Major depressive disorder Off label: Insomnia Anxiety Alzheimer disease Substance misuse Bulimia Fibromyalgia PTSD	FDA-approved:  Anxiety Anxiety-induced insomnia Long-lasting seizures Off label: Insomnia Nausea and vomiting from cancer treatments Acute agitation
Standard dosage	For depression: 50–100 mg two to three times daily Off-label for insomnia: 25 to 50 mg at night before bed	For anxiety: 2–6 mg daily, divided into three doses For procedural sedation: 0.05 mg/kg of body weight injected 2 hours pre-procedure or 0.044 mg/kg injected 15–20 minutes pre-procedure Off-label for insomnia: 2–4 mg at bedtime
Risks and restrictions to consider	Risk of suicidal thoughts Risk of serotonin syndrome	High risk of abuse and misuse Risk of serious or life-threatening breathing problems Mixing with alcohol could be dangerous or deadly
Side effects	Drowsiness Dry mouth Lightheadedness Headache Nausea	Dizziness  Drowsiness  Muscle weakness
Average cost without insurance*	$34 for 30, 50 mg tablets	$28 for 30, 0.5 mg tablets
SingleCare cost*	Get coupon	Get coupon
Learn more	More trazodone details	More lorazepam details

*Average cost at time of publication. Drug prices fluctuate and vary by pharmacy and location.

Bottom line

Trazodone is a generic antidepressant often used in the treatment of insomnia. Lorazepam is a fast-acting, generic benzodiazepine most often used to treat anxiety and panic attacks. However, it is also used off-label as a sleep aid. 

You can take both trazodone and lorazepam, but combining the two is not commonly recommended in an outpatient setting. If a healthcare provider does prescribe these drugs together, simultaneous use may be short-term. Ultimately, it’s important to consult a healthcare provider before combining any medications. Even prescription drugs that do not directly interact can cause dangerous problems when their adverse effects are compounded.