Trazodone vs. Xanax: Key differences, uses, and side effects

In this article:

• What are the main differences between trazodone and Xanax?
• Conditions treated by trazodone and Xanax
• Efficiacy
• Cost and coverage
• Side effects
• Interactions
• Warnings
• FAQs

In this article

• What are the main differences between trazodone and Xanax?
• Conditions treated by trazodone and Xanax
• Efficiacy
• Cost and coverage
• Side effects
• Interactions
• Warnings
• FAQs

Trazodone and Xanax (alprazolam) are two commonly prescribed medications that treat mental health conditions, but they are not the same. Trazodone is an antidepressant and is classified as a serotonin modulator. Trazodone works by increasing serotonin levels in the brain. On the other hand, Xanax is a brand name drug, with the generic name alprazolam. Xanax is part of the benzodiazepine class of drugs. It is used for various anxiety conditions. Xanax works by calming brain activity. Xanax enhances the activity of gamma-aminobutyric acid (GABA) receptors in the brain, which helps reduce anxiety and also has sedative effects. Continue reading to learn more about these medications, including their uses, side effects, drug interactions, and other important information. 

What are the main differences between trazodone and Xanax?

Trazodone is a generic medication and is available in the form of an oral tablet. The brand name, Desyrel, is no longer available in the United States. Xanax is a brand-name drug. Its generic is called alprazolam. It is available in several forms, including oral immediate-release and extended-release tablets, orally disintegrating tablets, and liquid. Xanax is classified by the DEA as a Schedule IV controlled substance because it has potential for abuse and dependence. 

Conditions treated by trazodone and Xanax

Trazodone is approved by the U.S. Food and Drug Administration (FDA) to treat major depressive disorder, or depression. Sometimes, healthcare providers prescribe trazodone for off-label uses (non FDA approved uses), such as insomnia (trouble sleeping), anxiety, Alzheimer’s disease, substance use disorder, bulimia, fibromyalgia, or post-traumatic stress disorder (PTSD). 

Xanax is FDA-approved for the acute treatment of generalized anxiety disorder. It can also be used to treat panic disorder with or without agoraphobia. Panic disorder is a condition where you have frequent, unexpected panic attacks. Agoraphobia is a fear of situations or places that may cause feelings of panic, embarrassment, or helplessness. Xanax is sometimes prescribed off-label for insomnia, premenstrual syndrome, or depression.

Is trazodone or Xanax more effective?

It is difficult to compare trazodone and Xanax directly. They have different FDA-approved uses, so clinical trials have not studied these drugs head to head. A small 1986 study compared Xanax and trazodone (along with a tricyclic antidepressant called imipramine) for panic disorder. The study found that Xanax was effective for panic disorder, while trazodone was not. However, trazodone is not typically used for panic disorder, so this study may not apply to real-world situations. 

As with all drugs that go through the FDA approval process, trazodone and Xanax have been extensively studied for safety and effectiveness. For the drugs to be approved, the pharmaceutical manufacturers had to prove they were safe and effective. Trazodone has been shown to be effective for depression, and Xanax has been shown to be effective for anxiety and panic disorder. However, we cannot compare the two drugs directly, as they are used for different conditions. 

The most effective treatment for you should only be determined by a healthcare provider, who can weigh the risks vs benefits of each drug and take into account individual factors such as your symptoms, medical conditions, and other medications you are taking that may interact with trazodone or Xanax. Additionally, your healthcare provider may recommend other non-medicinal treatments, such as cognitive behavioral therapy and relaxation techniques.

Coverage and cost comparison of trazodone vs. Xanax

Most insurance and Medicare prescription plans cover trazodone. For a typical prescription of trazodone, people who pay out of pocket would pay about $34. You can use a free SingleCare discount to pay as low as $4 per prescription. 

Most insurance plans cover alprazolam, which is generic Xanax. Some plans may cover the brand name, but may charge a higher copay or coinsurance. A typical Xanax prescription without insurance may cost around $257 for the brand name, but with a free SingleCare discount for generic alprazolam, you can pay as low as $8 for your prescription. 

Common side effects of trazodone vs. Xanax

The most common side effects of trazodone include:

• Edema (fluid retention)
• Blurry vision
• Fainting
• Drowsiness
• Tiredness 
• Diarrhea
• Stuffy nose
• Weight loss 

The most common side effects of Xanax include:

• Problems with coordination
• Low blood pressure
• Trouble speaking clearly
• Changes in libido (sex drive)

This is not a full list of side effects, and others may occur. Also, while less common, serious side effects may occur. With any medication, allergic reactions could occur. If you have symptoms of hives, difficulty breathing, or swelling of the face, lips, tongue, or throat, get emergency medical help right away. See the Warnings section for more information about serious side effects. You can also talk to your healthcare provider for more information about potential side effects.

Drug interactions of trazodone vs. Xanax

Before you take trazodone or Xanax, tell your healthcare provider about all the medications you take. This includes prescription drugs, over-the-counter (OTC) medicines, vitamins, and dietary supplements. You can discuss drug interactions with your healthcare provider. Some interactions may require avoiding the combination of drugs, while others may require a dosage adjustment and close monitoring.

Trazodone drug interactions include:

• Monoamine oxidase inhibitors (MAOIs) such as phenelzine or tranylcypromine. Combining an MAOI with trazodone can increase the risk of a dangerous and potentially life-threatening condition called serotonin syndrome. Trazodone should not be used within 14 days of taking an MAOI. 
• Other drugs that increase serotonin levels, such as SSRI or SNRI antidepressants, tricyclic antidepressants, triptans for migraine, opioid pain medicines, lithium, and St. John’s Wort. These can also increase the risk of serotonin syndrome if combined with trazodone.
• There is an increased risk of bleeding associated with trazodone. Taking trazodone with certain medicines, such as blood thinners (like warfarin or Xarelto), aspirin, or other nonsteroidal anti-inflammatory drugs (NSAIDs) can further increase the risk of bleeding.
• Strong CYP3A4 inhibitors, such as ketoconazole, itraconazole, or clarithromycin, may cause trazodone to stay in the body longer, which could increase the risk of serious side effects of trazodone.
• Strong CYP3A4 inducer,s such as phenytoin, rifampin, or carbamazepine, could make trazodone less effective by speeding up its removal from the body.
• Digoxin or phenytoin: Trazodone may increase the levels of these drugs in the body, which can potentially cause dangerous effects.
• Central nervous system (CNS) depressants, which are substances or drugs that slow down brain activity. These include alcohol, opioids, sleep aids, anxiety medicines, and muscle relaxants, among others. Trazodone may increase the effect of CNS depressants, which can cause extreme sedation, impairment, and slowed breathing. In severe cases, unconsciousness or death could occur.
• Drugs that affect heart rhythm such as quinidine, procainamide, amiodarone, ziprasidone, or chlorpromazine. This combination should generally be avoided, as combining these with trazodone can lead to heart rhythm problems.

Xanax drug interactions include:

• CNS depressants, including opioid pain medicines, alcohol, sleep aids, and other drugs mentioned above. These substances can have additive effects with Xanax, possibly leading to extreme sedation, impairment, and slowed breathing (see Warnings section).
• Strong CYP3A4 inhibitors, as mentioned above, which can lead to increased effects of Xanax in the body. This also includes other CYP3A4 inhibitors that are classified as moderate or weak, such as fluvoxamine or erythromycin.
• Strong CYP3A4 inducers, such as phenytoin or carbamazepine, can make Xanax less effective by speeding up its removal from the body.
• Digoxin. Xanax may increase the levels of digoxin in the body, which can potentially cause dangerous effects.

This is not a full list of drug interactions, and others may occur. Talk to your healthcare provider about potential interactions and how they may affect you.

Warnings of trazodone and Xanax

Before taking trazodone or Xanax, tell your healthcare provider about any medical conditions you have, including if you are pregnant, planning to become pregnant, or breastfeeding. 

Both trazodone and Xanax can cause impairment and drowsiness. Avoid alcohol, and do not drive or operate machinery until you know how the medication affects you. 

Trazodone warnings

Trazodone has a black box warning, which is the most serious warning required by the FDA. This warning states that antidepressants may increase the risk of suicidal thoughts and behaviors in children and young adults. People of any age who take trazodone should be closely monitored for any changes in mood or behavior, or suicidal thoughts and behaviors. 

In addition to the drug interactions mentioned above, other trazodone warnings include:

• Trazodone can cause orthostatic hypotension (a drop in blood pressure when standing up) and fainting. Talk to your healthcare provider about these risks if you have a history of low blood pressure.
• In rare cases, trazodone has been associated with priapism (prolonged, painful erection). Get medical help right away if you have a prolonged erection (more than 4 hours). 

Xanax warnings

Xanax has a black box warning, which states:

• Combining a benzodiazepine (like Xanax) and an opioid pain medication (such as oxycodone) can cause extreme drowsiness, breathing problems, coma, or even death. This combination should be avoided if possible. If the combination cannot be avoided, healthcare providers will prescribe the lowest possible doses and monitor you closely.
• Benzodiazepines are associated with abuse, misuse, and addiction, which can lead to overdose or death. Healthcare providers will monitor patients who take Xanax closely.
• Xanax should not be stopped abruptly after you have been taking it for a period of time. Suddenly stopping Xanax can cause withdrawal reactions, which can be life-threatening. If you need to stop taking Xanax, your healthcare professional will provide you with a tapering schedule so you can stop taking Xanax slowly and safely.

Frequently asked questions about trazodone vs. Xanax

What is trazodone?

Trazodone is a generic prescription medication used to treat depression. It works by increasing levels of serotonin in the brain, which helps with symptoms of depression. 

What is Xanax?

Xanax is a brand-name prescription medication used to treat anxiety and panic disorder. Because of its potential for substance abuse and dependence, it is a Schedule IV controlled substance. The generic name of Xanax is alprazolam.

Are trazodone and Xanax the same?

Trazodone and Xanax are not the same. Trazodone is an antidepressant medication, while Xanax is used for anxiety and panic disorders. These drugs belong to different classes and have different side effects, dosages, precautions, and drug interactions.  

Is trazodone or Xanax better?

Trazodone and Xanax are used for different conditions, so it’s not easy to say whether one is better than the other. Trazodone is FDA-approved to treat depression, while Xanax is FDA-approved for anxiety and panic disorders. You can consult your healthcare provider for more information and medical advice on the best treatment for you.  

Can I use trazodone or Xanax while pregnant?

The effects of trazodone during pregnancy are not fully understood. Researchers are not sure if trazodone can harm an unborn baby. Consult your healthcare provider for medical advice if you are pregnant or planning to become pregnant. 

Taking Xanax later in pregnancy can cause sedation and breathing problems in your baby, as well as possible withdrawal symptoms in the newborn after birth. Ask your healthcare professional for medical advice if you are pregnant or planning to become pregnant.

Can I use trazodone or Xanax with alcohol?

You should avoid alcohol while taking trazodone or Xanax. Combining these medications with alcohol can increase the risk of severe central nervous system (CNS) depression, leading to extreme sedation, impairment, and slowed breathing. In severe cases, this combination could result in unconsciousness or even death.

Will trazodone calm my anxiety?

Trazodone is FDA-approved for treating depression. Although it is not approved to treat anxiety, some doctors may prescribe it off-label for anxiety in certain situations. However, trazodone is not a first choice for anxiety. Generally, other medications such as selective serotonin reuptake inhibitors (SSRIs) or benzodiazepines, are used for anxiety. 

Always consult your healthcare provider for the best treatment options for your needs.