In every pregnancy, a woman starts out with a 3-5% chance of having a baby with a birth defect. This is called her background risk. This sheet talks about whether exposure to trazodone/nefazodone may increase the risk for birth defects over that background risk. This information should not take the place of medical care and advice from your health care provider.

What are trazodone and nefazodone?

Trazodone and nefazodone are antidepressants that are chemically similar. They are unrelated to other classes of antidepressants. Trazodone and nefazodone are also used to treat the symptoms of insomnia, tremors, anxiety disorders, and some pain syndromes. Trazodone is sold under the name Desyrel® and nefazodone is sold under the name for Serzone®.

I am taking trazodone/nefazodone, but I would like to stop taking it before becoming pregnant. How long does the drug stay in my body?

Individuals break down medicines at different rates. On average it takes about 5 days for most of the medicine either trazodone or nefazodone to be gone from the body once it is stopped.

I take trazodone/nefazodone and I am already pregnant. Should I stop taking it?

You should always speak with your health care provider before making any changes in your medication. If you do decide to stop after discussing it with your health care provider, you should gradually decrease the dose. These drugs should never be abruptly discontinued.

I have heard that trazodone/nefazodone can cause a miscarriage. Is this true?

There has been one study that compared the rates of miscarriage while taking trazodone/nefazodone. Although there were more miscarriages in the trazodone/nefazodone group, they were still within the expected rates of miscarriages for the general population.

Can taking trazodone/nefazodone during my pregnancy cause birth defects?

One study followed 147 women who took trazodone or nefazodone while pregnant. All of these women took the medication in the first trimester of pregnancy and more than a third of them took the medication throughout the entire pregnancy. There were 58 women exposed to trazodone and 89 exposed to nefazodone. There was no increase in birth defects above the normal 3-5% risk for the general population. The same group later reported no increase in birth defects in 17 pregnancies where trazodone was taken during the first trimester and 49 pregnancies where nefazodone was taken in the first trimester. While these studies are reassuring, the numbers are not large enough to completely rule out a risk.

Will taking trazodone/nefazodone have any effect on my baby’s behavior and development?

There are no studies on the behavior or development of infants exposed to these drugs during pregnancy. Long-term studies are needed in order to determine if there are any adverse effects on the baby’s behavior and development.

I need to take trazodone/nefazodone throughout my entire pregnancy. Will it cause withdrawal symptoms in my baby?

There have not been any reports that have shown a link between these drugs and withdrawal symptoms in infants. However, all babies who have been exposed during pregnancy to antidepressant drugs should be observed carefully after birth for any signs of withdrawal from the drug.

Can I take trazodone/nefazodone while breastfeeding?

Very small amounts of trazodone have been found in breast milk of women taking the drug. About 0.6% of trazodone passes into the breast milk and is ingested by the infant. There are no reports that have documented adverse effects from trazodone exposure due to breastfeeding.

There is one report that suggested that nefazodone caused harmful effects (extreme drowsiness, poor feeding and low body temperature) in a breastfed baby that was born prematurely. Even though the amount of nefazodone that the baby was exposed to through breast milk was very small, it is possible that the medication had more of an effect because the baby was premature.

Because of the low levels of trazodone and nefazodone in breast milk, most breastfed babies are unlikely to experience side effects. Be sure to talk to your health care provider about all your choices for breastfeeding.

What if the father of the baby takes trazodone/nefazodone?

There is currently no information to suggest that use of trazodone/nefazodone by the father would negatively affect the sperm or increase the risk for birth defects. In general, exposures that fathers have are unlikely to increase risks to a pregnancy. For more information, please see the MotherToBaby fact sheet Paternal Exposures and Pregnancy at http://www.mothertobaby.org/files/paternal.pdf.

Selected References:

  • Einarson A, et al. 2003. A multicentre prospective controlled study to determine the safety of trazodone and nefazodone use during pregnancy. Can J Psychiatry
  • 48(2):106-110.
  • Einarson A, et al. 2009. Incidence of major malformations in infants following antidepressant exposure in pregnancy: results of a large prospective cohort study. Can J Psychiatry 54(4):242 246.
  • Rivett KF and Barcelona PS. 1974. Toxicology of trazodone.Mod Probl Pharmacopsychiatry 9:76-86.
  • Verbeeck RK, et al. 1986. Excretion of trazodone in breast milk. Br J Clin Pharmacol. 22(3):367-370.
  • Yapp P, et al. 2000. Drowsiness and poor feeding in a breast-fed infant: association with nefazodone and its metabolites. Ann Pharmacother 34(11):1269-1272.