Trazodone Dosing: Maximum Recommended Dose
Yes, trazodone can be increased beyond 150mg up to a maximum of 400mg/day for outpatients and 600mg/day for inpatients, according to FDA guidelines. 1
Recommended Dosing Guidelines
The FDA-approved dosing for trazodone provides clear parameters:
- Initial dose: 150mg/day in divided doses
- Gradual increase: 50mg/day every 3-4 days based on response and tolerance
- Maximum outpatient dose: 400mg/day in divided doses
- Maximum inpatient dose: 600mg/day in divided doses 1
Dosing Considerations
Administration Timing
- For optimal therapeutic benefit with minimal side effects, consider administering a larger portion of the daily dose at bedtime 1, 2
- Single nighttime dosing has shown equal efficacy to multiple daily dosing for depression treatment, with improved sleep and less daytime drowsiness 2
Dose Adjustments
- Dose increases should be gradual (50mg every 3-4 days) to minimize side effects 1
- Drowsiness may require administering most of the dose at bedtime or reducing the overall dosage 1
- Consider dose reduction when co-administered with strong CYP3A4 inhibitors 1
Safety Considerations
Common Side Effects
- Somnolence, headache, dizziness, and dry mouth are most common 3
- Sedation is the most frequently reported side effect 2
Monitoring for Adverse Effects
- Watch for orthostatic hypotension, particularly in elderly patients or those with cardiovascular disease 3, 4
- Monitor for QT interval prolongation and cardiac arrhythmias, though these are less common than with tricyclic antidepressants 3, 4
- Be alert for rare episodes of priapism 3
Special Populations
- Elderly patients typically tolerate maximum doses of 300-400mg/day 4
- Younger patients may tolerate up to 600mg/day 4
Clinical Efficacy
- Therapeutic plasma concentration range for trazodone is 650-1500 ng/mL 5
- For full antidepressant efficacy, doses of 200-300mg are typically needed 2
- Trazodone has comparable efficacy to other antidepressants with potentially fewer anticholinergic and cardiovascular side effects 6, 4
Important Precautions
- Screen for bipolar disorder before starting treatment 1
- Allow at least 14 days between MAOI use and trazodone initiation or discontinuation 1
- When discontinuing, gradually reduce the dose rather than stopping abruptly 1
Trazodone's unique pharmacodynamic profile makes it particularly useful for patients with depression accompanied by insomnia, with therapeutic doses typically ranging from 150-300mg/day 3.