Trazodone Dosing Recommendations
The recommended dosing for trazodone is an initial dose of 25 mg per day, with a maximum of 200 to 400 mg per day in divided doses. 1
General Dosing Guidelines
Trazodone is classified as a mood-stabilizing (antiagitation) drug rather than an SSRI. It's commonly used for:
- Insomnia
- Mood stabilization
- Agitation control, particularly in patients with dementia
Initial Dosing
- Start with 25 mg per day, typically at bedtime 1
- For elderly patients or those with sensitivity to medications, starting at a lower dose may be appropriate
Titration
- Gradually increase dose as needed and tolerated
- Can be increased using increments of the initial dose every 5-7 days until therapeutic benefits or significant side effects become apparent 1
Maintenance Dosing
- Effective antidepressant dosing range: 150-400 mg/day
- For insomnia without depression: 50-100 mg at bedtime 2
- Maximum recommended dose: 200-400 mg per day in divided doses 1
- For elderly patients: Maximum tolerated doses are typically 300-400 mg/day 3
Administration Strategies
Single Nighttime Dosing vs. Divided Doses
- Studies comparing single nighttime dosing to multiple daily dosing have shown equal efficacy in relieving depression 4
- At treatment onset, a single nighttime dose is more productive of sleep with less daytime drowsiness 4, 5
- For optimal antidepressant effect: 150 mg given predominantly at bedtime, increased as needed to 200-300 mg 4
- Single nighttime dosing tends to have fewer reported side effects, particularly dry mouth, headache, and drowsiness 5
Special Considerations
Cautions
- Use with caution in patients with premature ventricular contractions 1
- Monitor for orthostatic hypotension, particularly in elderly patients
- Pregnancy: No teratogenic effects observed in animal studies at doses up to 11 times the maximum recommended human dose, but increased fetal resorption and other adverse effects were observed at higher doses 6
Side Effect Management
- Sedation is the most common side effect 4
- Unlike benzodiazepines, trazodone does not cause tolerance or rapid eye movement rebound on discontinuation 4
- Lower incidence of anticholinergic and cardiovascular effects compared to older tricyclic antidepressants, making it potentially more suitable for elderly patients 3
Discontinuation
- After 9 months of treatment, dosage reduction can be used to reassess the need for medication
- Discontinue over 10-14 days to limit withdrawal symptoms 1
Clinical Pearls
- Trazodone's 3-9 hour half-life favors dosing weighted at bedtime 4
- For insomnia treatment, 50-100 mg/day (particularly 100 mg) has been shown effective when administered as a single dose before bedtime 2
- Trazodone may be particularly useful in patients who are intolerant of anticholinergic effects of other antidepressants or have cardiac conduction disturbances 7
- Food delays absorption and reduces peak serum concentration, but does not alter total bioavailability 7
By following these dosing guidelines, clinicians can optimize the therapeutic benefits of trazodone while minimizing potential adverse effects.