What is the starting dose of trazodone (an antidepressant medication) 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, with a maximum dose of 100 mg when used for insomnia. 1

Dosing Guidelines

• For insomnia treatment:

  • Initial dose: 25 mg at bedtime
  • Titration: Gradually increase as needed
  • Maximum recommended dose: 100 mg for insomnia 1

• For depression treatment:

  • Initial dose: 150 mg (predominantly at bedtime)
  • Effective antidepressant range: 200-300 mg/day 2
  • Maximum dose: 300-400 mg/day in elderly patients 1, 3
  • For younger adults: Up to 600 mg/day may be tolerated 3

Pharmacological Considerations

Trazodone has a half-life of 3-9 hours, making it well-suited for nighttime administration 2. Its sedating properties make it particularly effective for patients with insomnia, which is why lower doses (25-100 mg) are commonly used for sleep disorders 1.

At lower doses (25-100 mg), trazodone primarily acts as a serotonin antagonist with sedative effects, while higher doses (150-300 mg) are required for full antidepressant efficacy 2, 4.

Efficacy Evidence

• A dose-finding study demonstrated that trazodone at 50-100 mg/day improved sleep disorders, with better results at the 100 mg/day dosage 5
• Trazodone is particularly effective for sleep maintenance insomnia but less effective than hypnotics for sleep onset insomnia 1
• The American Academy of Sleep Medicine notes that trials of 50 mg doses showed only minimal efficacy compared to placebo 1

Safety Considerations and Side Effects

• Common side effects: Sedation (most common), headache, dizziness, and dry mouth 4
• Serious but rare side effects: Priapism 1
• Cardiovascular considerations:
  • Use with caution in patients with cardiac issues, particularly those with premature ventricular contractions 1
  • Monitor for orthostatic hypotension, especially in elderly patients 1, 3
  • Potential for QT interval prolongation and cardiac arrhythmias 4

Special Populations

• Elderly patients:

  • Use lower starting doses
  • Maximum dose should be limited to 300-400 mg/day 1, 3
  • Monitor closely for orthostatic hypotension 1

• Patients with hepatic impairment:

  • Consider dose reduction when used with strong CYP3A4 inhibitors 1

Important Clinical Pearls

• Screen for bipolar disorder before initiating treatment 1
• Gradually reduce dosage when discontinuing rather than stopping abruptly 1
• Trazodone has minimal anticholinergic activity, making it potentially advantageous over older tricyclic antidepressants, especially in elderly patients 3, 6
• Trazodone is relatively safe in overdose compared to tricyclic antidepressants 3, 6
• Regular follow-up every few weeks during initial treatment is advised to assess effectiveness and side effects 1