What is the recommended dose of trazodone (antidepressant medication) for insomnia (sleep disorder)?

From the Guidelines

Trazodone is typically prescribed at a dose of 50 mg for sleep, as this dose has been shown to reduce sleep latency by 10 minutes and wake after sleep onset by 8 minutes, compared to placebo 1. When considering trazodone for sleep, it's essential to weigh the potential benefits against the potential harms, as outlined in the clinical practice guideline for the pharmacologic treatment of chronic insomnia in adults 1.

• The recommended dose of 50 mg is based on trials that demonstrated a mean reduction in sleep latency and wake after sleep onset, with no improvement in quality of sleep, compared to placebo 1.
• It's crucial to note that trazodone is not FDA-approved specifically for insomnia, but it is commonly prescribed off-label for this purpose due to its sedating properties.
• Potential side effects of trazodone include dizziness, dry mouth, and morning drowsiness, so it's best to take it when you have time for a full night's sleep (7-8 hours) 1.
• As with any medication, individual needs may vary based on medical history and other medications being taken, so it's essential to follow the healthcare provider's prescription and guidance.

From the FDA Drug Label

1. Dosage and Administration 2. 1 Dose Selection An initial dose of 150 mg/day in divided doses is suggested. The dosage should be initiated at a low-dose and increased gradually, noting the clinical response and any evidence of intolerance. Occurrence of drowsiness may require the administration of a major portion of the daily dose at bedtime or a reduction of dosage.

The dose of trazodone for sleep is not explicitly stated in the label, but it can be inferred that a major portion of the daily dose can be administered at bedtime to manage drowsiness. The initial dose is 150 mg/day and can be increased by 50 mg/day every 3 to 4 days. However, the label does not provide a specific dose for sleep, and the dosing should be individualized based on the patient's response and tolerance 2.

• The maximum dose for outpatients is 400 mg/day in divided doses.
• Inpatients may be given up to 600 mg/day in divided doses.

From the Research

Trazodone Dosage for Sleep

• The ideal dose of trazodone for sleep is not explicitly stated in the provided studies, but one study mentions a dosage of 100mg trazodone combined with cognitive behavior therapy (CBT) for primary insomnia 3.
• Another study compares the effects of trazodone versus CBT in patients with insomnia with short sleep duration, but does not specify the dosage of trazodone used 4.
• It is essential to note that the dosage of trazodone for sleep may vary depending on individual patient needs and should be determined by a healthcare professional.
• Trazodone is often used off-label for insomnia, and its efficacy and safety have been evaluated in various studies, including those that examine its use in combination with CBT 5, 3, 4.

Efficacy of Trazodone for Sleep

• Studies suggest that trazodone can be effective in improving sleep outcomes, including sleep latency, sleep efficiency, and total sleep time 3, 4.
• Trazodone has been shown to increase slow wave sleep duration when combined with CBT, which may be beneficial for patients with insomnia 3.
• However, the efficacy of trazodone for sleep may depend on individual patient characteristics, such as the presence of comorbid mental health conditions or the specific phenotype of insomnia 4.

Comparison with Cognitive Behavioral Therapy

• CBT is considered a first-line treatment for insomnia, and its efficacy has been established in various studies 6, 7.
• Some studies suggest that trazodone may be more effective than CBT in certain patient populations, such as those with insomnia with short sleep duration 4.
• However, CBT is generally considered a safe and effective treatment for insomnia, with few side effects and long-term benefits 7.