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

From the Guidelines

Trazodone is not recommended for the treatment of chronic insomnia disorder due to its adverse effect profile outweighing its benefits, as evidenced by a systematic review that showed no differences in sleep efficiency or rate of discontinuation due to adverse events between trazodone and placebo 1.

Recommended Usage

For major depressive disorder, trazodone is typically started at 150 mg daily, divided into two or three doses with food, and gradually increased to an effective dose of 150-400 mg daily.

• The maximum recommended dose is 600 mg daily.
• For insomnia, a lower dose of 25-100 mg taken once at bedtime is usually effective, however, its use is not recommended due to the risks associated with it 1.

Important Considerations

• Trazodone should be taken consistently, and patients should avoid abrupt discontinuation to prevent withdrawal symptoms.
• It may take 2-4 weeks to experience the full antidepressant effects, though sleep improvements often occur sooner.
• Trazodone works by increasing serotonin levels in the brain and blocking certain serotonin receptors, which helps regulate mood and sleep.
• Common side effects include drowsiness, dizziness, dry mouth, and blurred vision.
• Patients should be aware that trazodone may cause priapism (prolonged erection) in males, which requires immediate medical attention, and orthostatic hypotension (drop in blood pressure when standing), so caution is advised when getting up from lying or sitting positions 1.

Alternatives and Precautions

• The work group advised against use of antihistamines and antipsychotics for treatment of chronic insomnia disorder due to their adverse effect profiles and lack of evidence supporting their use 1.
• Over-the-counter complementary and integrative health treatments, such as kava, valerian, and chamomile, have been found to be ineffective or have serious potential harms, and their use is not recommended 1.

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 and 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: Shortly after a meal or light snack, can be swallowed whole or as a half tablet 2

From the Research

Recommended Dosage and Usage of Trazodone

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

• The usual antidepressant doses are 150-300 mg/day, which may be higher than the doses used when Trazodone is prescribed to augment the antidepressant effect of another medication 3, 4.
• Trazodone can be administered in a single daily dose, preferably at bedtime, to improve sleep and reduce daytime drowsiness 5, 6.
• The dose can be increased as needed to 200-300 mg for full antidepressant efficacy, but it is recommended to start with a lower dose and gradually increase it to minimize side effects 5, 6.
• In geriatric patients, the dose should be lower, typically not exceeding 300-400 mg/day, due to the increased risk of side effects such as orthostatic hypotension and arrhythmias 6, 7.

Administration and Pharmacokinetics

• Trazodone has a 3- to 9-hour half-life and its pharmacokinetics favor a dose weighted at bedtime 5.
• The once-daily formulation of Trazodone has single-dose pharmacokinetic properties that maintain effective blood Trazodone levels for 24 hours, while avoiding concentration peaks associated with side effects 3.
• Trazodone is metabolized by the CYP450 isoenzyme, mainly the 2D6 and 3A4, which requires its dose to be adjusted when administered simultaneously with other drugs influencing the activity of those isoenzymes 6.

Efficacy and Safety

• Trazodone is efficacious for the treatment of a broad array of depressive symptoms, including symptoms that are less likely to respond to other antidepressants, such as insomnia 3, 4.
• Trazodone has a relatively low risk of side effects, such as weight gain, sexual dysfunction, and anticholinergic effects, compared to other antidepressants 3, 4, 6.
• Common adverse effects of Trazodone include somnolence, headache, dizziness, and xerostomia, but these are generally mild and well-tolerated 3, 6.