What is the dose range of trazodone (an antidepressant medication) for conditions like depression and insomnia?

Trazodone Dosage Range for Depression and Insomnia

The recommended dose range for trazodone is 25-50 mg initially for insomnia, with a maximum of 200-400 mg daily in divided doses; for depression, the initial dose is 150 mg/day in divided doses with a maximum of 400 mg/day for outpatients and 600 mg/day for inpatients. 1, 2

Dosing for Insomnia

Initial Dosing

• Start with 25-50 mg taken approximately 30 minutes before bedtime 1, 3
• Administer shortly after a meal or light snack to minimize side effects 2

Titration and Maximum Dosing

• For insomnia, doses typically remain low (25-100 mg) 4, 5
• Maximum dose for insomnia should not exceed 200 mg 1, 3
• The 50 mg dose has shown efficacy for insomnia with minimal side effects 5

Important Considerations

• Trazodone is considered a third-line agent for insomnia, after CBT-I and FDA-approved hypnotics 3, 1
• The American Academy of Sleep Medicine recommends against using trazodone as a first-line treatment for insomnia 3
• Low-dose trazodone shows only modest benefits for insomnia (approximately 10 minutes improvement in sleep latency) 3

Dosing for Depression

Initial Dosing

• Start with 150 mg/day in divided doses 2
• For elderly patients, consider lower starting doses 6

Titration

• Increase by 50 mg/day every 3-4 days based on response and tolerability 2
• Dose may be weighted toward bedtime to minimize daytime sedation 7

Maximum Dosing

• Outpatients: Maximum 400 mg/day in divided doses 2
• Inpatients (more severely depressed): Maximum 600 mg/day in divided doses 2
• Elderly patients: Maximum tolerated doses are typically 300-400 mg/day 6

Administration Recommendations

• Trazodone can be taken as a single nighttime dose or divided doses throughout the day 7
• For depression with insomnia, a single nighttime dose regimen may be preferred 7, 8
• Tablets can be swallowed whole or administered as a half tablet by breaking along the score line 2
• Always take shortly after a meal or light snack to reduce side effects 2

Cautions and Monitoring

• Use with caution in patients with premature ventricular contractions 1
• Monitor for orthostatic hypotension, particularly in elderly patients 6
• Drowsiness is the most common side effect and is dose-dependent 4
• Gradually reduce dosage when discontinuing rather than stopping abruptly 2
• Screen for bipolar disorder before initiating treatment 2

Special Populations

• Elderly patients: Lower starting doses and maximum doses (300-400 mg/day) 6
• Patients with hepatic impairment: Consider dose reduction when used with strong CYP3A4 inhibitors 2
• Patients on concomitant medications: Adjust dose if taking strong CYP3A4 inhibitors or inducers 2

Trazodone's sedating properties make it particularly useful for patients with depression and comorbid insomnia, though at different dose ranges depending on the primary indication 8.