Medication Selection Page

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Step 1 of 5 - Select a Sleep Medication

Select a Sleep Medication

Clonidine

Trazodone

Hydroxyzine

Clonidine

Brand Name: Catapres
Available Doses: Immediate-release tablets: 0.1 mg, 0.2 mg, and 0.3 mg
Minimum / Maximum Dose: 0.05 – 0.3 mg nightly

What is Clonidine?

Clonidine is a centrally acting alpha-2 adrenergic agonist that was originally developed to lower blood pressure. Over time, its off-label uses have expanded significantly. It is now frequently prescribed to manage insomnia, anxiety, ADHD, and even opioid withdrawal symptoms. By reducing sympathetic nervous system activity, clonidine induces a calming, sedative effect, which makes it effective for sleep.

Additionally, clonidine is used in some cases for post-traumatic stress disorder (PTSD), tics (Tourette’s syndrome), and hot flashes related to menopause. Emerging research also explores its role in mitigating inflammatory responses, making it a topic of interest in conditions like Long COVID.

The Doctors’ Insights

In clinical practice, clonidine is an effective and underutilized sleep aid, especially for individuals who struggle with racing thoughts, stress-related insomnia, or ADHD-related sleep disturbances. It works quickly, helping patients fall asleep within 30 to 60 minutes without the risk of addiction or tolerance buildup.

Unlike some sedative medications, clonidine rarely causes morning grogginess because it lacks the lingering effects of drugs like trazodone or certain antihistamines. However, it is not ideal for everyone. Some individuals experience dizziness, dry mouth, or mild next-day fatigue, especially at higher doses.

For those with ADHD, clonidine provides additional benefits beyond sleep, including reduced hyperactivity, improved impulse control, and decreased emotional reactivity. Because of its blood pressure-lowering properties, it is not recommended for patients prone to dizziness or fainting unless closely monitored.

Pros & Cons

Pros:

Cons:

Common side effects include dry mouth, dizziness, fatigue, and constipation.
Abrupt discontinuation of high doses taken multiple times per day (which is not how we prescribe it) can result in withdrawal symptoms, such as rebound hypertension.
It can occasionally cause low blood pressure. Therefore, caution is advised for patients with naturally low blood pressure, a tendency to feel dizzy upon standing suddenly, or a history of fainting (syncope).

All Side Effects

Medications to Avoid with Clonidine
Certain drugs can increase side effects or pose risks when combined with clonidine:

Other blood pressure medications → Risk of excessively low blood pressure (hypotension)
Sedatives and sleep aids → Increased drowsiness (benzodiazepines, alcohol, antihistamines, opioids)
Stimulants (ADHD meds like Adderall, Ritalin) → Can cause blood pressure fluctuations when combined
Beta-blockers → Risk of severe blood pressure drops if clonidine is stopped suddenly

Always consult your provider before combining clonidine with other medications.

Trazodone

Brand Names: Desyrel, Oleptro
Available Doses: 50 mg, 100 mg, and 150 mg tablets (immediate-release).
Minimum / Maximum Dose: 25 to 200 mg at bedtime.

What is Trazodone?

Trazodone is an antidepressant that is often prescribed off-label for insomnia due to its sedative properties. It works by modulating serotonin, a brain chemical that influences mood and sleep. Trazodone is also used to treat depression, anxiety, and certain behavioral issues.

The Doctors’ Insights

Trazodone is one of the most widely preferred and frequently used treatments for insomnia, offering an effective, safe, and non-addictive option. One of its standout benefits is its ability to enhance deep, slow-wave sleep—the most restorative sleep stage, essential for physical recovery, cognitive function, and emotional well-being.

Trazodone works by modulating serotonin levels while also blocking histamine and alpha-adrenergic receptors, promoting relaxation and deep sleep.

Because it has a lower potential for abuse compared to many other sleep aids, trazodone is often considered a safer long-term option for individuals needing consistent sleep support. Its sedative effects help with both falling asleep and staying asleep, making it particularly beneficial for those with fragmented sleep patterns.

That said, approximately 10% of patients report mild “morning hangover” effects, experiencing grogginess or sluggishness for the first hour after waking. Additionally, about 5% of patients may experience temporary dysphoria or irritability. If these side effects occur, it is important to monitor symptoms and discuss potential dose adjustments or alternative treatments with your provider.

When taken correctly, trazodone provides an effective, non-habit-forming solution for improving sleep quality, helping many patients achieve deeper, more refreshing rest.

Pros & Cons

Pros:

Cons:

View All Side Effects Here

Medications to Avoid with Trazodone

Certain drugs can increase side effects or pose risks:

Serotonergic drugs (risk of serotonin syndrome): SSRIs, SNRIs, MAOIs, tramadol, St. John’s wort
Other sedatives (excessive drowsiness): benzodiazepines, opioids, alcohol, sleep aids
QT-prolonging drugs (heart arrhythmias): some antibiotics, antipsychotics, antiarrhythmic
CYP3A4 inhibitors/inducers (altered trazodone levels): antifungals, antibiotics, HIV meds, rifampin
Always inform your provider about your medications.

Always consult your provider before combining clonidine with other medications.

Pregnancy and Breastfeeding Considerations

Pregnancy

Trazodone is not recommended during pregnancy due to limited human studies and potential risks, including effects on fetal development. While some providers may consider it in specific cases, our policy does not support prescribing trazodone if pregnancy occurs. Patients who are pregnant or planning pregnancy should consult their doctor for safer alternatives for sleep management.

Breastfeeding

Trazodone passes into breast milk in small amounts, but its effects on infants remain unclear. Reports suggest possible sedation, poor feeding, and respiratory issues in breastfeeding infants. Our policy does not support the use of trazodone while breastfeeding. Patients should discuss alternative options with their healthcare provider.

Hydroxyzine

Brand Name: Vistaril

Available Doses: 25 mg and 50 mg capsules or tablets.

Minimum / Maximum Dose: 25 – 100 mg at bedtime.

What is Hydroxyzine?

Hydroxyzine is an antihistamine commonly prescribed for its calming and sedative effects. It is used to treat anxiety, insomnia, itching from allergies, nausea, and even mild pain relief. It works by reducing central nervous system activity and blocking histamine, which causes allergic reactions. Unlike benzodiazepines, hydroxyzine is non-addictive and does not lead to dependence, making it a safer option for long-term use.

The Doctors’ Insights

Hydroxyzine is a versatile medication that effectively helps both falling asleep and staying asleep. It is particularly useful for individuals who struggle with anxiety-related insomnia, as it promotes relaxation without the risk of dependence seen with other sleep aids.
One of the key benefits of hydroxyzine is its fast-acting sedative effect, making it a reliable option for those who have difficulty initiating sleep. Additionally, it helps maintain sleep by reducing nighttime awakenings. Unlike some stronger medications, it does not disrupt normal sleep cycles, allowing for a more natural rest.

However, about 10% of patients report mild morning tiredness as the medication gradually leaves their system. This effect is typically dose-dependent and can often be minimized by adjusting the dosage or taking it earlier in the evening. When used correctly, hydroxyzine provides a safe, non-addictive alternative for improving sleep quality.

Pros & Cons

Pros:

Cons:

All Side Effects

Medications to Avoid with Hydroxyzine

Some medications can interact with hydroxyzine, increasing the risk of side effects or adverse reactions:
Central nervous system depressants (risk of excessive drowsiness): Benzodiazepines, opioids, alcohol, sleep aids.
QT-prolonging drugs (risk of heart arrhythmias): Certain antibiotics, antipsychotics, antiarrhythmic.
Antihistamines (risk of enhanced side effects): Diphenhydramine, promethazine.
CYP3A4 inhibitors (may increase hydroxyzine levels): Some antifungals, antibiotics, HIV medications.
Always inform your provider about your medications to avoid potential interactions.

Always consult your provider before combining clonidine with other medications.

Common Effects:

Uncommon Effects:

View All Side Effects Here

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