What is the starting dose of trazodone (antidepressant) for adults?

Starting Dose of Trazodone for Adults

The recommended starting dose of trazodone for adults is 25 mg at bedtime, which can be gradually increased as needed. 1, 2

Dosing Guidelines by Indication

For Insomnia:

• Initial dose: 25-50 mg at bedtime 2
• Maximum dose: 200 mg daily 2
• Dose should be taken shortly after a meal or light snack to reduce side effects
• Trazodone at 50 mg shows only minimal efficacy for primary insomnia compared to placebo 1

For Depression:

• Initial dose: 150 mg/day in divided doses 2
• Can be increased by 50 mg/day every 3-4 days based on response and tolerability 2
• Maximum dose: 400 mg/day for outpatients, 600 mg/day for inpatients 2
• For elderly patients with depression: lower starting doses with maximum 300-400 mg/day 2

Dosing Strategy

1. Start low: Begin with 25 mg at bedtime, especially for insomnia or in elderly patients 1, 2
2. Titrate slowly: Increase dose gradually based on response and side effects
3. Administration timing:
   • For insomnia: Single dose at bedtime
   • For depression: Can be given as a single nighttime dose or divided throughout the day 3

Special Considerations

• Elderly patients: Lower starting doses are particularly important
• Patients with cardiac issues: Use with caution in patients with premature ventricular contractions 1
• Hepatic impairment: Consider dose reduction when used with strong CYP3A4 inhibitors 2
• Side effect profile: Most common side effect is sedation 3
  • At 50 mg, reported side effects include headache (30% vs 19% placebo) and somnolence (23% vs 8% placebo) 1
  • Monitor for orthostatic hypotension, particularly in elderly patients 2
  • Rare but serious side effect: priapism 1

Efficacy Considerations

• For insomnia: Trazodone is considered a third-line agent after CBT-I and FDA-approved hypnotics 2
• For depression: Studies show trazodone is as effective as other antidepressants when dosed appropriately 4
• Single nighttime dosing (versus multiple daily dosing) has shown equal efficacy for depression with better sleep outcomes and less daytime drowsiness initially 3

Monitoring

• Regular follow-up every few weeks during initial treatment to assess effectiveness and side effects 2
• Use the lowest effective maintenance dose and taper medication when conditions allow 2
• Monitor for orthostatic hypotension, arrhythmias, and priapism 4

Starting with a low dose of 25 mg and gradually titrating upward allows for assessment of individual response while minimizing side effects, making it the safest approach for most adult patients.