From the Guidelines
Trazodone is not recommended as a treatment for sleep onset or sleep maintenance insomnia in adults, due to its adverse effect profile and limited efficacy, as suggested by the American Academy of Sleep Medicine clinical practice guideline 1. The guideline recommends against using trazodone for insomnia, based on trials of 50 mg doses, citing its limited benefits and potential harms. Instead of trazodone, other medications such as suvorexant, eszopiclone, zaleplon, zolpidem, and ramelteon are suggested as treatments for sleep onset and sleep maintenance insomnia in adults, with specific dose recommendations for each medication 1. It's essential to consult a doctor before starting any medication for sleep, as they can help determine the best course of treatment and potential interactions with other medications. The American Academy of Sleep Medicine guideline provides a comprehensive summary of clinical practice recommendations for the pharmacologic treatment of chronic insomnia in adults, including the use of orexin receptor agonists, BZD receptor agonists, melatonin agonists, and heterocyclics 1. In general, it's crucial to prioritize the safety and efficacy of medications for insomnia, considering the potential risks and benefits, and to follow the recommendations of reputable clinical practice guidelines, such as those from the American Academy of Sleep Medicine 1.
From the Research
Recommended Dosage of Trazodone for Insomnia
The recommended dosage of trazodone for insomnia varies, but studies suggest the following:
- A dose of 50-100 mg/day can improve sleep disorders, particularly at the 100 mg/day dosage 2
- Low-dose use of trazodone (less than 100mg/d) is effective for the treatment of primary and secondary insomnia, including symptoms that are a result of depression, dementia, and being a healthy man 3
- Trazodone once-a-day (T-OAD) can be prescribed at a dose of 150 mg, which can be increased to 300 mg, and is potentially effective for depressive symptoms and improves treatment adherence 4
Considerations for Dosage
When considering the dosage of trazodone for insomnia, the following should be taken into account:
- Side effects are dose-dependent, and the most common is drowsiness 3
- High doses (≥100mg/d) may be associated with a higher incidence of side effects, such as sedation, dizziness, and psychomotor impairment 5
- Tolerance to trazodone may develop with long-term use 5
- Rare but serious side effects, such as parkinsonism, can occur even at moderate doses 6