Is Belsomra better than trazodone? (3+ indications)

This article will answer the question, “Is Belsomra better than trazodone?” We will also discuss the conditions in which Belsomra and trazodone are preferred and compare their mechanism of action, efficacy and side effects.

Is Belsomra better than trazodone? 

Belsomra could be a better option than trazodone for some individuals. Belsomra (Suvorexant) is an orexin receptor antagonist (ORA), which is a new class of drugs approved in 2014 to treat insomnia. Trazodone is an antidepressant used to treat a variety of symptoms associated with depression, anxiety, sleep-related disorders and drug-induced insomnia. (1,2)

However, the effect of the drug depends on the individual’s response; some individuals may respond to Belsomra better than trazodone, whereas some may not. Many other factors, such as genetics, underlying conditions, and concomitant drug use, can also influence the performance of the drug. 

The choice of the drug solely depends on your physician. Your physician will evaluate your condition and prescribe you the most appropriate drug to treat your symptoms. It is not recommended to self-medicate with Belsomra or trazodone as they can cause more harm than good if taken in the wrong way. 

How does Belsomra differ from trazodone? 

Belsomra and trazodone are two different medications used to treat insomnia and other conditions. The differences between Belsomra and trazodone are as follows: (2,3)

  Belsomra Trazodone
Active ingredient Suvorexant Trazodone
Mechanism of action It blocks orexin receptors (OX1R, OX2R), which promotes sleep.  It acts on serotonin reuptake receptors, serotonin type 2 receptors, H1 receptors and alpha-1-adrenergic receptors. 
Class Orexin receptor antagonist Serotonin-antagonist and reuptake inhibitor
Indication Insomnia Depression, anxiety, sleep-related disorder, Alzheimer’s disease, substance abuse, nightmares and insomnia in PTSD, fibromyalgia and bulimia.
Recommended dose 10-20 mg per night can be used up to 40 mg if well tolerated.  75-300 mg can be titrated up to 600mg in inpatients. 
Pregnancy  Category C (used if benefits outweigh the risk) Category C (used if benefits outweigh the risk)
Hepatic/renal impairment Dose adjustment not needed Dose adjustments are needed.

What does the research suggest? 

A meta-analysis study included 43 studies and 44 trials in which antidepressants, benzodiazepines, orexin receptor antagonists and antipsychotics were assessed for their efficacy in treating insomnia. The study found that the effect of suvorexant in wake after sleep onset was higher compared to other drugs. (4)

A 12-month clinical trial showed significant efficacy in treating insomnia when compared to placebo. The most common side effect reported was somnolence. The recommended dose of Belsomra is 10 mg once at night 30 minutes before bed, which can be increased up to 20mg. If 10mg is not well tolerated, the dose can be reduced to 5 mg. (1)

Studies have shown that 100mg of trazodone is effective in improving sleep quality. However, the dose may differ based on individual response. (2) In one of the studies conducted by Xiao-yan Yi et al. showed that trazodone was effective in reducing the number of early awakenings. However, they couldn’t find any significant improvement in sleep efficiency. (5)

What should you be aware of while using Blesomra or trazodone? 

Blesomra is a Schedule 4 drug available with a prescription and should not be consumed without a physician’s guidance. Blesmora is a sedative used to treat insomnia and should be taken only at night 30 minutes before going to sleep. 

Belsomra may interact with medications like CYP3A inhibitors (e.g. fluconazole) and CYP3A inducers (e.g. rifampin), which can alter its plasma concentration. Therefore, it should be used with caution.

It is recommended to take trazodone in the evening or near bedtime and not in the morning because of its sedative effect. Concomitant use of trazodone with monoamine oxidase inhibitors, linezolid, triptans, tricyclic antidepressants, aspirin, NSAIDs and fentanyl is contraindicated as it increases the risk of serotonin syndrome. 

Symptoms of serotonin syndrome can range from mild (nausea, vomiting, hypertension, increased heart rate) to severe (seizure, tremors, altered mental status, rhabdomyolysis, shock, etc.). If you notice any unwanted side effects during combination therapy with antidepressants, make sure to consult your physician. 

Abrupt discontinuation of Belsomra did not cause any rebound insomnia or withdrawal symptoms in clinical trials. However, abrupt discontinuation of trazodone can cause withdrawal symptoms; hence, it is important to taper the dose before discontinuing antidepressants such as trazodone. 

Monitor for side effects which occur during the use of Belsomra and trazodone treatment. The side effects caused by Belsomra and trazodone are: 

Belsomra Trazodone
  • Drowsiness
  • Somnolence
  • Sedation
  • Muscle weakness
  • Abnormal dreams
  • Headache
  • Dizziness/light-headedness
  • Drowsiness
  • Headache
  • Nause/vomiting
  • Somnolence
  • Dry mouth
  • Orthostatic hypertension 
  • Priapism (painful erection)
  • Suicidal thoughts
  • Mania
  • Hypertension


In my opinion, Belsomra may be a better drug to treat insomnia as it has fewer side effects and is solely indicated to treat sleep disorders. However, due to individual variabilities, some may benefit from Belsomra and others from trazodone. I recommend you consult a physician who will evaluate your condition and prescribe you a proper treatment regimen according to your needs. Avoid self-medicating with these drugs, as they need careful monitoring and dosing. 

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Lie JD, Tu KN, Shen DD, Wong BM. Pharmacological treatment of insomnia. Pharmacy and Therapeutics. 2015 Nov;40(11):759. Available from: 


Shin JJ, Saadabadi A. Trazodone. [Updated 2022 Jul 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: 


Bennett T, Bray D, Neville MW. Suvorexant, a dual orexin receptor antagonist for the management of insomnia. Pharmacy and Therapeutics. 2014 Apr;39(4):264. Available from:,B%2C%20neuropeptides%20that%20promote%20wakefulness. 


Zheng X, He Y, Yin F, Liu H, Li Y, Zheng Q, Li L. Pharmacological interventions for the treatment of insomnia: quantitative comparison of drug efficacy. Sleep Medicine. 2020 Aug 1;72:41-9. Available from: 


Yi XY, Ni SF, Ghadami MR, Meng HQ, Chen MY, Kuang L, Zhang YQ, Zhang L, Zhou XY. Trazodone for the treatment of insomnia: a meta-analysis of randomized placebo-controlled trials. Sleep medicine. 2018 May 1;45:25-32. Available from: 

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