Trazodone Discontinuation When Changing Sleep Medications
Trazodone should be tapered rather than abruptly discontinued when changing sleep medications due to the risk of withdrawal symptoms. 1
Withdrawal Risks with Abrupt Discontinuation
- The FDA label for trazodone explicitly warns that abrupt discontinuation can lead to withdrawal symptoms including anxiety, agitation, and sleep problems 1
- As a serotonergic medication, trazodone discontinuation may cause symptoms such as nausea, sweating, dysphoric mood, irritability, dizziness, sensory disturbances (like electric shock sensations), tremor, confusion, headache, and emotional lability 1
- A gradual reduction in dosage rather than abrupt cessation is specifically recommended in the FDA prescribing information 1
Recommended Tapering Approach
- When switching from trazodone to another sleep medication, implement a gradual taper of trazodone while introducing the new medication 1
- For patients on lower doses used for insomnia (25-50mg), tapering can typically be accomplished over 1-2 weeks 2
- Higher doses may require longer tapering periods to minimize withdrawal effects 1
- Consider reducing the dose by 25-50% every 3-4 days until discontinuation 1
Special Considerations
- Elderly patients may be more sensitive to withdrawal effects and may require more gradual tapering 3
- Patients with a history of anxiety disorders may experience more pronounced withdrawal symptoms and benefit from slower tapering 1
- Monitor for emergence or worsening of insomnia during the transition period 3
Important Caveats
- Trazodone is not FDA-approved for insomnia and is used off-label for this purpose 3
- The American Academy of Sleep Medicine recommends against using trazodone for insomnia treatment due to limited efficacy evidence compared to potential harms 2, 4
- When switching sleep medications, consider FDA-approved alternatives such as suvorexant, eszopiclone, zolpidem, zaleplon, ramelteon, or low-dose doxepin (3-6 mg) which are recommended by the American Academy of Sleep Medicine 2
- Cognitive behavioral therapy for insomnia (CBT-I) should be considered as first-line treatment for chronic insomnia 2
Monitoring During Transition
- Assess for withdrawal symptoms including anxiety, agitation, and sleep disturbances during the tapering process 1
- Monitor for potential drug interactions between trazodone and the new sleep medication if there will be a period of overlap 1
- Be vigilant for serotonin syndrome if transitioning to another serotonergic medication 1
- Evaluate overall sleep quality, onset, and maintenance during and after the transition 3