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Trazodone vs. Hydroxyzine for Sleep—A Comprehensive Guide

Trazodone vs. Hydroxyzine for Sleep—A Comprehensive Guide

The moon is high in the sky, casting long shadows while the world around you is silent—but you’re wide awake. The minutes have stretched into hours, each tick of the clock echoing the struggles of countless others who, like you, crave restful slumber.

You’ve tried sleeping medications like Ambien and Lunesta, meditation, lavender, and the digital detox of screen-free hours before bedtime, but they only provide short-term relief. Then you hear about trazodone and hydroxyzine, two drugs that can be potential game-changers in your quest for sleep.

Still, choosing the right option is challenging. This comprehensive trazodone vs. hydroxyzine for sleep comparison explains their benefits, mechanisms of action, and proper usage to help you make your choice.

How Does Trazodone Work?

Trazodone, sold under brand names like Desyrel, Desyrel Dividose, and Oleptro, is an FDA-approved medication primarily used for treating depression. The active ingredient in trazodone is a compound of the same name, which is classified as a serotonin modulator.

There’s no specific explanation of how trazodone works, but experts believe it inhibits serotonin uptake in the brain, increasing the hormone’s levels in the nerve cells.

Serotonin is a neurotransmitter that helps brain cells communicate with each other and influence activities like appetite regulation, thinking, and behavior. By maintaining the serotonin balance between the nerve synapse and the brain, trazodone can help improve your mood and sleep. 

The drug is available in tablet form in the following doses:

  1. 50 mg
  2. 100 mg
  3. 150 mg
  4. 300 mg

The typical dose for adults with insomnia is 25–100 mg, taken orally before bedtime. You should take trazodone after meals to reduce the chances of upsetting your stomach. 

Although the drug is suitable for long-term use, you should gradually decrease the dosage towards the end of treatment to reduce the risk of withdrawal symptoms. You must always consult your doctor on how to take the medication and get off of it.

Trazodone—Usage and Interactions


Trazodone can be prescribed to patients over 18 for treating depression and anxiety, but it’s also commonly used off-label to treat sleep disorders. Still, the drug isn’t suitable for everyone—certain health conditions can interact with trazodone, making it less effective or increasing the risk of side effects. Check out some of these interactions in the table below:



Bipolar disorder

Can trigger manic episodes


Can worsen symptoms

Heart disease

Can cause irregular heart rhythm


Can increase the frequency of seizures

Recent heart attack

Can put additional strain on the heart

Angle-closure glaucoma

Can worsen symptoms


Can trigger manic episodes


Can increase the frequency of seizures

Cardiovascular disease

Can cause irregular heart rhythm


Can worsen symptoms


Can further lower blood pressure

Trazodone can also interact with other medications, such as MAO inhibitors, stimulant medicines, opioids, herbal products, or drugs for depression, mental illnesses, Parkinson’s disease, and migraine, as well as antibiotics. You should inform your healthcare provider of any treatments or conditions you have before taking trazodone. 

While trazodone carries no risk of abuse and addiction according to the U.S. Drug Enforcement Administration (DEA), it can lead to psychological dependence. While it’s not classified as a controlled substance, this medication is only available by prescription.

The Side Effects of Trazodone

Most people tolerate trazodone well, but it can sometimes cause side effects. Common unwanted reactions to the medication include:

  • Headache
  • Dry mouth
  • Constipation
  • Dizziness or lightheadedness
  • Drowsiness or fatigue
  • Nervousness or confusion
  • Blurred vision
  • Nausea or vomiting

In rare cases, trazodone may cause severe adverse reactions. Seek immediate medical attention if you experience the following:

  • Chest pain 
  • Shortness of breath
  • Irregular heartbeat
  • Fainting
  • Bruising or bleeding
  • Seizures
  • Persistent nausea or vomiting 
  • Priapism (prolonged, painful erection)

Source: Kampus Production

How Does Hydroxyzine Work?

Hydroxyzine is an FDA-approved medication primarily used for treating allergies. The drug’s key ingredient is hydroxyzine hydrochloride, which is classified as an antihistamine.

Hydroxyzine’s sedative properties result from its interaction with histamine receptors in the central nervous system (CNS). By blocking these receptors, the drug induces a calming effect, making you feel drowsy and promoting sleep.

Hydroxyzine is available in tablet or liquid form in four doses:

  1. 10 mg
  2. 25 mg
  3. 50 mg
  4. 100 mg

The daily starting dose for sleep issues is 10 mg, but your doctor may prescribe a higher dose if you have severe sleep problems. You should take hydroxyzine at least 30 minutes before going to bed. You can take the drug without food, but experts recommend taking it with food if it upsets your stomach.

According to clinical studies, you should only use hydroxyzine for a maximum of four months because the effects of long-term use of the drug remain unknown. 

Hydroxyzine—Usage and Interactions

Hydroxyzine can be prescribed for patients over 18 for the treatment of itching and other allergy symptoms, and off-label for treating sleep and anxiety issues. Still, the drug may not suit individuals with certain health conditions due to the possibility of reduced potency or increased risk of side effects. Learn about hydroxyzine’s interactions with some conditions in the table below:



Digestive tract obstruction

Can exacerbate symptoms, making it more difficult for food to pass through the digestive tract 

Urinary retention or other urination issues

Can make it more difficult to urinate


Can increase intraocular pressure, worsening glaucoma symptoms

Cardiovascular disease or slow heartbeats

Can slow heart rate further, potentially leading to complications

Long QT syndrome

Can prolong the QT interval, potentially leading to irregular heart rhythms

Electrolyte imbalance

Can exacerbate heart rhythm abnormalities

Recent heart attack

Can put additional strain on the heart

Allergies to cetirizine and levocetirizine

Patients are advised to consider safe alternatives

Hydroxyzine can potentially interact with other medications, such as opioids, sedatives, amiodarone, antipsychotics, and some antibiotics.

Hydroxyzine is non-addictive, and the DEA doesn’t classify it as a controlled substance. Still, you should follow your doctor’s guidelines to reduce the risk of developing psychological dependence.

You should inform your primary care physician of your health history and any substances and supplements you’re using before taking the medication. Pregnant and breastfeeding women should also consult their healthcare providers before using these drugs.

The Side Effects of Hydroxyzine

Patients rarely experience adverse reactions to hydroxyzine since it’s taken under their doctor’s guidance. When taking the drug, special attention should be paid to seizures and decreased responsiveness.

Other side effects of hydroxyzine may include:

  • Nausea
  • Dizziness
  • Drowsiness
  • Dry mouth
  • Headache

Serious side effects may include:

  • Irregular heartbeat
  • Tremors or convulsions
  • Severe dizziness or fainting
  • Difficulty breathing or swallowing
  • Hives or skin rash

These lists aren’t exhaustive—consult your healthcare provider for comprehensive details on these drugs’ side effects. To reduce the risk of adverse reactions, follow your doctor’s dosing instructions. 

If you experience dizziness and drowsiness after waking up, avoid driving or operating machinery until they subside.

Trazodone vs. Hydroxyzine—Which Is Better for Sleep?

Trazodone and hydroxyzine are highly effective for sleeplessness, but their efficacy depends on your health status, lifestyle, and particular sleep issues. 

Only a sleep specialist can determine what would work best for you, but finding one can be time-consuming since less than 1% of doctors are trained in sleep medicine. The good news is that telemedicine platforms like Kick can help you connect with a sleep doctor and get immediate help for your problems.

For an all-encompassing treatment, check out Kick’s program designed by a Stanford sleep specialist, Dr. Alex Dimitriu.

Kick—The Key to Better Sleep


Kick’s sleep program offers an innovative approach to tackling sleep issues. It entails a swift and convenient consultation process, unlike traditional visits where patients wait up to several months to meet with a sleep specialist. The comprehensive sleep intake form takes 15 minutes to complete and is reviewed within 24 hours, allowing you to start treatment quickly.

Our sleep specialist will assess your medical history and current health status and prescribe two trial medications. You will then meet regularly via the Kick platform, where your doctor will share tips on healthy sleep hygiene. If the initial medications don’t yield the desired results, the expert will prescribe new drugs to optimize your treatment quickly.

Kick’s positive Trustpilot reviews attest to the effectiveness of our sleep program:

“So glad I found you! I cannot express how grateful I am for the piece of mind your product/service has brought me. I am finally able to relax and find peace. Highly suggest to reach out if you all need help. It is easy and convenient.”

Karen, U.S.

Getting Started With Kick

To join Kick, take these simple steps:

  1. Go to our Sleep Visit page
  2. Complete the medical form with your current health status and medical history so we can determine the best treatment for you
  3. Choose your preferred delivery method—home delivery or local pharmacy pickup
  4. Provide your shipping address and payment details

If our specialist determines we can’t effectively treat your condition, you won’t pay for the consultation, as per our Doctor Guarantee.

Can You Take Trazodone and Hydroxyzine Together?


You should consult your healthcare provider to determine whether it’s safe to take hydroxyzine and trazodone together. These medications have moderate interactions, and using them simultaneously can increase the risk of adverse reactions like irregular heartbeats.

Your doctor may recommend taking both medications if the benefits outweigh the risks. They’ll also monitor you closely during treatment and adjust the dosage if necessary. 

Trazodone and Hydroxyzine—Alternatives To Consider

If your healthcare provider decides trazodone and hydroxyzine aren’t the best solutions to your sleep problems, they may recommend alternatives. Some of them are:


Best Suited For

Benadryl (Diphenhydramine HCI)

Short-term treatment of insomnia, especially when caused by allergies

Valium (Diazepam)

Short-term treatment of insomnia related to anxiety


Short-term treatment of insomnia

Xanax (Alprazolam)

Short-term treatment of insomnia related to anxiety or panic disorders


Short-term treatment of insomnia related to anxiety or stress

Zoloft (Sertraline)

Treatment of insomnia related to depression

Ativan (Lorazepam)

Short-term treatment of insomnia related to anxiety

Most of these drugs are used for short-term treatment, so you should inform your doctor if your sleep issues persist after discontinuing the medication.

Trazodone vs. Hydroxyzine—A Short Overview

Check out the table below for a concise comparison of trazodone and hydroxyzine:




Primarily indicated for


Allergies, itching

Class of drug

Serotonin receptor antagonists and reuptake inhibitors


Available doses

50 mg, 100 mg, 150 mg, and 300 mg

10 mg, 25 mg, 50 mg, and 100 mg



Tablet, oral suspension, injection

FDA approval



Controlled substance



Brand name/generic

Brand names: Desyrel, Desyrel Dividose, Oleptro

Brand names: Astarax, Vistaril

Suitable for children


Yes (only for treating FDA-approved conditions and not sleep issues)

Pregnancy category

Category C (potential risk)

Category C (potential risk)

No matter which drug you opt for, combining it with a holistic approach to sleep issues will deliver the best results. For personalized sleep treatment, consider Kick’s sleep program and start waking up energized!

Featured image source: Ketut Subiyanto