BACKGROUND: The last few years have seen a remarkable rise in the off-label use 
of trazodone for inducing sleep in nondepressed patients, to a degree that it is 
prescribed for this purpose as commonly as the leading hypnotic. In view of this 
widespread popularity, it seems prudent to review what is known of the safety 
and efficacy of trazodone when used in this context.
DATA SOURCES AND SELECTION: A MEDLINE search of the literature published in 
English between 1975 and 2003 that included the keywords sleep, trazodone, 
Desyrel, depression, sleeping pill, and sedative-hypnotics was conducted.
DATA SYNTHESIS: From this review, it is concluded that there are very few data 
to suggest that trazodone improves sleep in patients without mood disorder, 
though it does increase total sleep in patients with major depressive disorder. 
There are virtually no dose-response data for trazodone vis-à-vis sleep and, 
similarly, no available data on tolerance to its possible hypnotic effects. 
Areas of concern with its use include reports of significant dropout rates and 
induction of arrhythmias, primarily in patients with histories of cardiac 
disease, as well as the development of priapism.
CONCLUSION: In summary, there are few data to support the use of trazodone in 
nondepressed subjects. When the risk-benefit ratio of trazodone is assessed, its 
side effect profile, which is much more significant than that of conventional 
hypnotics, should be considered.