What is the maximum recommended dose of trazodone (Selective Serotonin Reuptake Inhibitor) per day?

Maximum Dose of Trazodone

The maximum recommended dose of trazodone is 400 mg per day according to the FDA drug label. 1

Dosing Guidelines

Trazodone dosing varies based on indication:

• For mood stabilization/anti-agitation in Alzheimer's disease:

  • Initial dose: 25 mg per day
  • Maximum dose: 200-400 mg per day in divided doses 2

• For depression:

  • Initial dose typically starts at lower ranges (50-150 mg)
  • Maximum dose for adults: 400 mg per day 1
  • For elderly patients: Maximum tolerated doses are 300-400 mg/day 3
  • For younger patients: Doses up to 600 mg/day may be tolerated, though this exceeds the FDA-approved maximum 3

Administration Recommendations

Trazodone is best administered as:

• Single nighttime dose when possible (especially for sleep disorders)
• Divided doses when higher total daily amounts are needed
• Studies show equal efficacy between single nighttime dosing and multiple daily dosing for depression 4, 5

For optimal antidepressant efficacy, trazodone is best dosed at 150 mg given predominantly at bedtime and increased as needed to 200-300 mg 4.

Special Populations and Precautions

Cardiac Patients

• Use with caution in patients with premature ventricular contractions 2
• Lower doses (100-300 mg) are better tolerated and more effective in patients with significant cardiovascular disease 6

Elderly Patients

• Lower maximum doses (300-400 mg/day) are recommended 3
• Single nighttime dosing may be preferred to reduce daytime drowsiness 4

Common Side Effects

• Sedation (most common side effect)
• Drowsiness
• Orthostatic hypotension
• Arrhythmias (rare but should be monitored)
• Priapism (rare but serious)

Clinical Pearls

1. Trazodone has a half-life of 3-9 hours, which favors nighttime dosing 4
2. When used for insomnia, lower doses (50-100 mg) are typically effective 7
3. Trazodone has fewer anticholinergic and cardiovascular effects compared to older tricyclic antidepressants, making it potentially safer for elderly patients 3
4. Trazodone is relatively safe in overdose compared to tricyclic antidepressants 3

While trazodone is often described as an SSRI in clinical shorthand, it is technically a serotonin antagonist and reuptake inhibitor (SARI), which explains its different side effect profile compared to traditional SSRIs.