Safe Maximum Dose of Trazodone
The safe maximum dose of trazodone is 400 mg per day for outpatients and 600 mg per day for inpatients (hospitalized patients) with depression, administered in divided doses. 1
Dosing Guidelines
Trazodone dosing varies based on patient setting and condition being treated:
- For depression (outpatients): Maximum 400 mg/day in divided doses 1
- For depression (inpatients): Maximum 600 mg/day in divided doses 1
- For mood stabilization/antiagitation: Maximum 200-400 mg/day in divided doses 2
Initial Dosing and Titration
- Start with 25-150 mg/day (lower doses for elderly or when used for sleep/agitation)
- Increase gradually by 50 mg every 3-4 days based on response and tolerability 1
- For mood stabilization in Alzheimer's patients, start at 25 mg per day 2
Administration Recommendations
- Take shortly after a meal or light snack to improve absorption 1
- Can be swallowed whole or broken along score line 1
- Consider administering a major portion of the daily dose at bedtime to minimize daytime drowsiness 1, 3
- Single nighttime dosing may be more productive for sleep with less daytime drowsiness 3
Special Populations
Elderly Patients
- Maximum tolerated doses are typically 300-400 mg/day 4
- Lower starting doses recommended (typically 25-75 mg)
- Increased risk of orthostatic hypotension in elderly patients
Patients with Cardiac Issues
- Use with caution in patients with premature ventricular contractions 2
- Monitor for cardiovascular effects, particularly orthostatic hypotension
Common Side Effects and Monitoring
- Most common: Drowsiness, sedation (beneficial for insomnia)
- Cardiovascular: Orthostatic hypotension, arrhythmias (less common than with tricyclic antidepressants)
- Other: Dizziness, dry mouth, gastrointestinal disturbances
- Rare but serious: Priapism (requires immediate medical attention)
Important Precautions
- Drug interactions: Reduce dose when used with strong CYP3A4 inhibitors 1
- Discontinuation: Gradually reduce dosage rather than stopping abruptly 1
- Serotonin syndrome risk: Use with caution when combined with other serotonergic medications 2
- Bipolar screening: Screen for bipolar disorder before initiating treatment 1
Clinical Pearls
- Trazodone at 50-100 mg/day can be effective for sleep disorders when given as a single dose before bedtime 5
- Lower doses (25-150 mg) are typically effective for insomnia, while higher doses are needed for antidepressant effects
- Trazodone has a relatively favorable safety profile in overdose compared to tricyclic antidepressants 4
- Half-life of 3-9 hours supports once-daily dosing, particularly at bedtime 3