Maximum Dose of Trazodone
The maximum recommended daily dose of trazodone is 400 mg per day for outpatients and up to 600 mg per day for inpatients, given in divided doses. 1
Dosing Framework
Standard Adult Dosing
- Starting dose: 25-50 mg per day 1
- Typical therapeutic range: 150-400 mg per day 2, 3
- Maximum outpatient dose: 400 mg per day 1, 4
- Maximum inpatient dose: 600 mg per day 5
- Administration: Divided doses throughout the day 1
Context-Specific Dosing
For Alzheimer's Disease/Agitation 1:
- Initial: 25 mg per day
- Maximum: 200-400 mg per day in divided doses
- Use with caution in patients with premature ventricular contractions
- Usual adult dose: 150-400 mg daily in two divided doses
- Higher doses up to 600 mg/day tolerated by younger patients
- Elderly patients: maximum tolerated doses 300-400 mg/day
For Insomnia 7:
- Low-dose sedating use: typically 50 mg 8
- Note: The 2017 American Academy of Sleep Medicine guideline suggests NOT using trazodone for insomnia treatment based on trials of 50 mg doses, citing insufficient efficacy 8
Critical Dosing Considerations
Common Prescribing Error
A retrospective chart review found that trazodone is frequently underdosed in clinical practice 5. The study revealed:
- Mean starting dose was only 113.7 mg/day (below the recommended 150 mg/day starting dose)
- Mean final dose was 217.9 mg/day (far short of optimal levels of 250-350 mg/day)
- This underdosing may contribute to the clinical impression of reduced efficacy compared to tricyclic antidepressants
Dosing Strategy
- Increase dosage using increments of the initial dose every 5-7 days until therapeutic benefits or significant side effects appear 1
- For depression treatment, doses below 250 mg/day are often subtherapeutic 5
- Single night-time dosing (100-400 mg) shows equivalent efficacy to divided daily dosing with potentially fewer daytime side effects 9
Safety Profile at Maximum Doses
Trazodone is relatively safe in overdose compared to tricyclic antidepressants 3, 6. However, monitor for:
- Orthostatic hypotension (dose-related)
- Cardiac arrhythmias (less common than with TCAs)
- Priapism (rare but serious)
- Drowsiness/sedation (most common, dose-dependent)
Hepatic/Renal Impairment
Dose reduction recommended in hepatic disease; consider reduction in renal disease 2
FDA-Approved Maximum
The FDA label specifies a maximum recommended human dose (MRHD) of 400 mg/day in adults 4. This represents the standard outpatient maximum, though inpatient settings may use up to 600 mg/day under close monitoring 5.