From the Guidelines
The maximum safe dose of trazodone for adults is typically 400 mg per day, as indicated by the most recent guidelines 1.
Important Considerations
When considering the use of trazodone, it's crucial to weigh the benefits against the potential risks, especially in elderly patients or those with certain medical conditions.
- Trazodone is usually started at a low dose of 25-50 mg at bedtime and gradually increased as needed and tolerated.
- For elderly patients, the maximum dose should be lower, generally not exceeding 200-300 mg daily.
- Trazodone works primarily by inhibiting serotonin reuptake and blocking certain serotonin receptors, with sedative effects that make it particularly useful for depression accompanied by insomnia.
Side Effects and Precautions
Side effects can include drowsiness, dizziness, dry mouth, and priapism (prolonged erection) in men, which requires immediate medical attention.
- Blood pressure monitoring is important as trazodone can cause orthostatic hypotension, especially when starting treatment or increasing doses.
- Trazodone should be taken after meals to reduce the risk of dizziness and to improve absorption.
- Patients should avoid abruptly stopping trazodone as this may cause withdrawal symptoms; dose reduction should be gradual under medical supervision.
Evidence-Based Recommendations
The guidelines from the management of chronic insomnia disorder and obstructive sleep apnea 1 suggest that trazodone may not be the first-line treatment due to its adverse effect profile, but it can be considered in certain cases. However, the most recent and relevant guideline for the use of trazodone in the context of managing Alzheimer's disease and related conditions 1 provides the basis for the recommended maximum safe dose.
From the FDA Drug Label
The maximum dose for outpatients usually should not exceed 400 mg/day in divided doses. Inpatients (i.e., more severely depressed patients) may be given up to but not in excess of 600 mg/day in divided doses. The safest maximum dose of trazodone is:
- 400 mg/day for outpatients, in divided doses
- 600 mg/day for inpatients (more severely depressed patients), in divided doses 2
From the Research
Trazodone Dosage
The safest maximum dose of trazodone varies depending on the patient population and the specific condition being treated.
- In elderly patients, the maximum tolerated dose is typically 300 to 400 mg/day 3.
- In younger patients, doses of up to 600 mg/day may be tolerated 3.
- For antidepressant efficacy, trazodone is often dosed at 150 to 300 mg/day, with some studies suggesting that a single nighttime dose is more effective in improving sleep and reducing daytime drowsiness 4, 5.
- The usual adult daily dose of trazodone hydrochloride is 150-400 mg given in two divided doses 6.
Special Considerations
- In patients with sleep disorders accompanied by a depressive state, a single dose of 50-100 mg/day before bedtime may be effective in improving sleep disorders 7.
- Trazodone has a low incidence of serious adverse effects, but may cause somnolence, headache, dizziness, and xerostomia, as well as orthostatic hypotension, QT interval prolongation, cardiac arrhythmias, and rare episodes of priapism 5, 6.
- The drug's pharmacodynamic properties allow it to avoid the side effects of insomnia, anxiety, and sexual dysfunction often associated with selective serotonin reuptake inhibitor antidepressants 5.
Dosage Recommendations
- The American studies recommend starting with a low dose of 150 mg/day and increasing as needed to 200 to 300 mg for full antidepressant efficacy 4.
- Other studies suggest that trazodone may be effective at lower doses, such as 50-100 mg/day, for specific conditions like sleep disorders accompanied by a depressive state 7.