Trazodone Dosage Titration Guidelines
When increasing trazodone from 50 mg to 150 mg, you should wait 3-4 days between dose increases of 50 mg to monitor for side effects and tolerability. 1
Recommended Titration Schedule
Trazodone dosing should follow a gradual titration approach to minimize side effects, particularly sedation which is the most common adverse effect:
- Starting dose: 50 mg at bedtime
- First increase: Increase to 100 mg after 3-4 days if tolerated
- Second increase: Increase to 150 mg after another 3-4 days if needed
This approach aligns with the FDA-approved labeling which states: "The dose may be increased by 50 mg/day every 3 to 4 days" 1.
Rationale for Gradual Titration
- Pharmacokinetics: Trazodone has a half-life of 3-9 hours, allowing for assessment of side effects within a few days 2
- Side effect profile: Sedation is the most common side effect (23% vs 8% in placebo), followed by headache (30% vs 19% in placebo) 3
- Orthostatic hypotension risk: Particularly concerning in elderly patients, requires monitoring during dose escalation 3
- Tolerability assessment: Gradual titration allows for assessment of individual response and tolerability before reaching higher doses
Dosing Considerations
- Administration timing: Trazodone should be taken shortly after a meal or light snack 1
- Bedtime administration: Due to sedative effects, administering the major portion of the daily dose at bedtime may improve tolerability 1
- Maximum doses:
- Outpatients: Should not exceed 400 mg/day in divided doses
- Inpatients: Up to 600 mg/day in divided doses for more severely depressed patients 1
- Elderly patients: Maximum tolerated doses are typically 300-400 mg/day 4
Special Considerations
- Screen for bipolar disorder: Prior to initiating treatment or increasing dose 1
- Drug interactions: Consider dose adjustments if taking strong CYP3A4 inhibitors or inducers 1
- Discontinuation: Always taper gradually rather than stopping abruptly to avoid withdrawal symptoms 1
Monitoring During Titration
- Sedation/drowsiness: Most common side effect, may require dose adjustment or timing modification
- Orthostatic hypotension: Monitor blood pressure, particularly in elderly patients
- Cardiac effects: Watch for arrhythmias, especially in patients with pre-existing cardiac conditions
- Priapism: Rare but serious side effect requiring immediate medical attention 3
By following this 3-4 day titration schedule between dose increases, you can optimize the safety and efficacy of trazodone therapy while minimizing adverse effects.