What is the recommended protocol for tapering off trazodone (antidepressant)?

Trazodone Tapering Protocol

Trazodone should be gradually tapered rather than abruptly discontinued, with a recommended tapering schedule of 10% reduction per week or 10% per month for longer-term users, with adjustments based on patient tolerance and withdrawal symptoms. 1

Recommended Tapering Approach

• The FDA drug label explicitly states that trazodone should be gradually reduced rather than stopped abruptly whenever possible to avoid discontinuation symptoms 1
• Initial reductions should be small (5-10% of current dose) to build patient confidence in the process and minimize withdrawal symptoms 2
• Each new dose should be 90% of the previous dose rather than a straight-line taper from the starting dose 2
• For patients on long-term trazodone therapy, slower tapers (10% per month or slower) are more appropriate than faster tapers 2, 3
• The tapering process may take several months depending on the initial dose and duration of treatment 2

Managing Withdrawal Symptoms

• Trazodone withdrawal can cause physical and psychological symptoms including anxiety, irritability, insomnia, and general discomfort 3
• Withdrawal symptoms can occur despite gradual discontinuation, suggesting the need for very slow tapering rates 3
• The short half-life of trazodone and its metabolite m-chlorophenylpiperazine may contribute to withdrawal symptoms, requiring more gradual dose reductions 3
• Adjunctive medications may be helpful for managing specific withdrawal symptoms:
  • For insomnia: Consider temporary use of alternative sleep aids 2
  • For anxiety or irritability: Short-term supportive interventions may be beneficial 2, 4

Important Considerations

• Discontinuation symptoms are generally mild and self-limiting but can be distressing and impact daily functioning 4
• If withdrawal symptoms become severe, consider temporarily returning to the previous dose and then resuming tapering at a slower rate 2, 4
• The target dose may not necessarily be zero; some patients may benefit from continuing at a lower maintenance dose 2
• Close monitoring and support during the tapering process are critical to success 2
• Withdrawal symptoms can be mistaken for recurrence of the original condition (depression, insomnia), potentially leading to unnecessary long-term medication 4, 5

Practical Implementation

• Start with very small dose reductions (5% of current dose) if the patient is anxious about tapering or has previously experienced withdrawal symptoms 2
• For patients on higher doses, consider tapering to 50% of the original dose before implementing the 10% reduction schedule 2
• Hyperbolic tapering (making proportionally smaller reductions as the dose gets lower) may be more effective than linear tapering for minimizing withdrawal symptoms 5
• If the patient is also taking benzodiazepines, address the benzodiazepine taper first due to the higher risks associated with benzodiazepine withdrawal 6

By following this gradual tapering approach and providing appropriate support for withdrawal symptoms, most patients can successfully discontinue trazodone with minimal discomfort and reduced risk of relapse.