What is the recommended dosage and usage of Trazodone (an antidepressant medication) for treating major depressive disorder or insomnia?

From the Guidelines

Trazodone is not recommended as a first-line treatment for insomnia, and its usage should be carefully considered due to the availability of other effective treatments with more robust evidence supporting their use. When considering trazodone for major depressive disorder, the typical starting dose is 150 mg daily, divided into multiple doses with meals, with gradual increases by 50 mg every 3-4 days if needed, up to a maximum of 400 mg daily for outpatients or 600 mg for hospitalized patients 1. For insomnia, although not the preferred choice, a lower dose of 25-100 mg taken 30 minutes before bedtime may be considered, but this is based on clinical practice rather than strong guideline recommendations.

Key Considerations for Trazodone Use

• Trazodone should be taken with food to reduce side effects like dizziness and lightheadedness.
• Patients should avoid alcohol while taking this medication and use caution when driving or operating machinery, as it can cause drowsiness.
• Elderly patients typically require lower doses.
• Trazodone works by increasing serotonin levels in the brain, which helps regulate mood and sleep patterns.
• The sedating effects occur at lower doses, which is why smaller amounts are effective for insomnia, while higher doses are needed for antidepressant effects.
• Improvement in depression symptoms may take 2-4 weeks, though sleep benefits often appear sooner.
• Patients should not stop taking trazodone abruptly as this may cause withdrawal symptoms.

Evidence-Based Recommendations

Given the guidelines from the American Academy of Sleep Medicine, as outlined in the study 1, trazodone is not suggested as a treatment for sleep onset or sleep maintenance insomnia in adults, based on trials of 50 mg doses. This recommendation is crucial when considering the treatment options for patients with insomnia, emphasizing the need to prioritize treatments with stronger evidence supporting their efficacy and safety.

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 may be increased by 50 mg/day every 3 to 4 days 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.
2. 2 Important Administration Instructions Trazodone Hydrochloride Tablets can be swallowed whole or administered as a half tablet by breaking the tablet along the score line. Trazodone Hydrochloride Tablets should be taken shortly after a meal or light snack.

The recommended dosage and usage of Trazodone for treating major depressive disorder or insomnia is as follows:

• Initial dose: 150 mg/day in divided doses
• Dose increase: 50 mg/day every 3 to 4 days
• Maximum dose:
  • Outpatients: 400 mg/day in divided doses
  • Inpatients: 600 mg/day in divided doses
• Administration: Tablets can be swallowed whole or administered as a half tablet, and should be taken shortly after a meal or light snack 2

From the Research

Recommended Dosage and Usage of Trazodone

The recommended dosage and usage of Trazodone for treating major depressive disorder or insomnia are as follows:

• The initial dose of Trazodone is typically 150 mg given predominantly at bedtime, which can be increased as needed to 200 to 300 mg for full antidepressant efficacy 3.
• Trazodone can be dosed once daily, with its pharmacokinetics favoring a dose weighted at bedtime 3.
• For the treatment of insomnia, Trazodone has been shown to be effective at low doses, with the most common side effect being drowsiness 4.
• In patients with major depressive disorder and insomnia, Trazodone is efficacious for the treatment of a broad array of depressive symptoms and is particularly useful for patients presenting with insomnia as one of the symptoms of depression 5.

Efficacy and Safety of Trazodone

The efficacy and safety of Trazodone have been demonstrated in several studies:

• Trazodone has established efficacy that is comparable to other available antidepressants, and is effective for a range of depression symptoms, including insomnia 6.
• The side effects of Trazodone are dose-dependent, with the most common being somnolence, headache, dizziness, and xerostomia 6.
• Trazodone has minimal anticholinergic activity, but may be associated infrequently with orthostatic hypotension, QT interval prolongation, cardiac arrhythmias, and rare episodes of priapism 6.
• Trazodone is relatively safe in overdose, with a low incidence of weight gain and sexual dysfunction, making it a useful option for many depressed patients 6, 7.

Special Considerations

Special considerations for the use of Trazodone include:

• Geriatric patients respond similarly to Trazodone, with maximum tolerated doses of 300 to 400 mg/day 3, 7.
• Trazodone may be of use in elderly patients in whom anxiety and insomnia are problematic, and in those patients who are unresponsive to or cannot tolerate therapy with other agents 7.
• Further clinical experience is needed to confirm the preliminary results of using Trazodone as a hypnotic for psychotropic-induced or other insomnias 7.