What is the maximum recommended dose of trazodone (antidepressant) per day?

Maximum Recommended Dose of Trazodone

The maximum recommended dose of trazodone for outpatients is 400 mg per day in divided doses, while inpatients with more severe depression may receive up to 600 mg per day in divided doses. 1

Dosing Guidelines

Initial Dosing

• Starting dose: 25-150 mg per day 2, 3, 1
  • For most patients, begin with 25-50 mg at bedtime 3
  • FDA label suggests 150 mg/day in divided doses initially 1

Dose Titration

• Increase gradually by 50 mg/day every 3-4 days 1
• Adjust based on clinical response and tolerance 1
• Occurrence of drowsiness may require:
  • Administration of major portion of daily dose at bedtime
  • Reduction of dosage 1

Maximum Dosing

• Outpatients: Maximum 400 mg/day in divided doses 2, 3, 1
• Inpatients (more severely depressed): Maximum 600 mg/day in divided doses 1

Special Populations

Elderly Patients

• Maximum tolerated doses are typically 300-400 mg/day 4
• Lower doses are recommended for adults 75 years and older 3
• Elderly patients should be monitored closely for orthostatic hypotension 3, 4

Patients with Medical Conditions

• Use with caution in patients with premature ventricular contractions 2
• Consider dose reduction when coadministered with strong CYP3A4 inhibitors 1
• Consider dose increase when coadministered with strong CYP3A4 inducers 1

Administration Recommendations

• Take shortly after a meal or light snack 1
• Can be swallowed whole or administered as a half tablet by breaking along score line 1
• For antidepressant effect, the effective dosing range is 150-400 mg/day 3, 5
• For sleep/insomnia, lower doses are typically effective 5

Discontinuation

• Gradually reduce the dosage rather than stopping abruptly 1
• Taper over 10-14 days to limit withdrawal symptoms 3, 1

Common Side Effects

• Drowsiness (most common) 6, 5
• Headache, dizziness, and dry mouth 5
• Orthostatic hypotension (especially in elderly or those with cardiovascular disease) 4, 5
• Rare but serious: QT interval prolongation, cardiac arrhythmias, priapism 5

Trazodone has a relatively favorable side effect profile compared to other antidepressants, with low incidence of anticholinergic effects and cardiovascular effects, making it particularly useful for patients who cannot tolerate other antidepressants 4, 7.