From the Guidelines
The maximum recommended dose of trazodone is 400 mg per day in divided doses. This dosage is based on the guidelines for managing behavior and mood disorders, which recommend an initial dosage of 25 mg per day, with a maximum of 200 to 400 mg per day in divided doses 1. It's essential to note that trazodone should be used with caution in patients with premature ventricular contractions.
When considering the therapeutic range of trazodone, studies suggest that the recommended target plasma concentration range is 650-1500 ng/mL 1. However, this information is more relevant for therapeutic monitoring rather than determining the maximum daily dose.
In clinical practice, the dosage of trazodone may vary depending on the patient's condition, age, and response to treatment. For depression, treatment usually starts at a lower dose, and for insomnia, even lower doses are often sufficient. Elderly patients may require lower maximum doses due to increased sensitivity to side effects.
Key points to consider when prescribing trazodone include:
- Starting with a low dose and gradually increasing as needed
- Taking the medication with food to minimize side effects
- Being aware of the potential for sedation and adjusting the dose timing accordingly
- Monitoring for side effects, especially at higher doses, and adjusting the treatment plan under medical supervision.
It's crucial to prioritize the patient's safety and adjust the dosage based on their individual response to the medication, always keeping in mind the potential for side effects and the importance of therapeutic monitoring when necessary.
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 maximum recommended dose of trazodone per day is:
- 400 mg/day for outpatients
- 600 mg/day for inpatients 2
From the Research
Maximum Recommended Dose of Trazodone
The maximum recommended dose of trazodone varies depending on the patient's age and tolerance.
- In elderly patients, the maximum tolerated doses are 300 to 400 mg/day 3.
- In younger patients, higher doses of up to 600 mg/day are tolerated 3.
- Other studies suggest that trazodone can be effective at doses of 150-300 mg/day, with some patients requiring up to 400 mg/day 4, 5, 6.
- The dose can be increased as needed, but it is essential to monitor patients for potential side effects, such as drowsiness, orthostatic hypotension, and arrhythmias 3, 5.
Factors Influencing Dose
The dose of trazodone may be influenced by several factors, including:
- Age: Elderly patients may require lower doses due to decreased tolerance 3.
- Sleep disturbances: Patients with insomnia may benefit from a single nighttime dose of trazodone 4.
- Depression severity: Patients with moderate or severe depression may require higher doses 7.
- Anxiety symptoms: Patients with anxiety symptoms may benefit from peak blood concentrations of trazodone, which can be achieved with extended-release formulations 7.