What is the next dose of trazodone (antidepressant) when tapering down from 50mg?

Trazodone Tapering Protocol from 50mg

When tapering trazodone from 50mg, the next appropriate dose is 25mg. 1, 2, 3

Rationale for 25mg as Next Tapering Dose

• Trazodone is commonly prescribed at 50mg for insomnia, though clinical evidence suggests limited efficacy at this dose compared to placebo 1
• When tapering antidepressants including trazodone, a 50% dose reduction is generally considered appropriate to minimize withdrawal symptoms 2, 4
• For trazodone specifically, the 50mg to 25mg step represents a reasonable reduction that balances the need to taper gradually while moving toward discontinuation 3, 5

Tapering Considerations

• Trazodone has a half-life of 3-9 hours, which supports a once-daily dosing regimen typically administered at bedtime 2
• Side effects of trazodone at 50mg include headache (30% vs 19% with placebo) and somnolence (23% vs 8% with placebo), which may diminish during tapering 1
• Tapering helps minimize potential withdrawal effects, though these are generally less severe with trazodone compared to benzodiazepines 1, 4

Clinical Context

• The American Academy of Sleep Medicine suggests against using trazodone for insomnia (weak recommendation), as studies show only modest improvements in sleep parameters that fall below clinical significance thresholds 1
• Sleep latency reduction with trazodone 50mg was only 10.2 minutes compared to placebo, below clinical significance 1
• Total sleep time increased by only 21.8 minutes, also below clinical significance threshold 1

Practical Tapering Protocol

1. Reduce from 50mg to 25mg for 1-2 weeks 2, 5
2. If well-tolerated, consider further reduction to 12.5mg for 1-2 weeks before discontinuation 4
3. Monitor for potential withdrawal symptoms including sleep disturbance, irritability, or anxiety 1, 5

Special Considerations

• If trazodone was prescribed for depression rather than insomnia, tapering should be more gradual and coordinated with alternative antidepressant therapy 5
• Patients with cardiovascular disease require careful monitoring during tapering due to potential for orthostatic hypotension 4
• Elderly patients may be more sensitive to dose changes and may benefit from more gradual tapering 1, 4

Monitoring During Tapering

• Assess for return of insomnia symptoms, which may indicate need for alternative sleep interventions 1
• Monitor for withdrawal effects, though these are typically milder with trazodone than with other sedative-hypnotics 4
• Consider non-pharmacological approaches to insomnia management during and after tapering 1