Trazodone Tapering Protocol
Yes, trazodone should be gradually tapered rather than abruptly discontinued to prevent withdrawal symptoms. 1, 2
Why Tapering Is Necessary
- The FDA drug label explicitly states: "Advise patients not to abruptly discontinue Trazodone Hydrochloride Tablets and to discuss any tapering regimen with their healthcare provider. Adverse reactions can occur when Trazodone Hydrochloride Tablets are discontinued." 1
- Discontinuation syndrome from trazodone can include nausea, sweating, dysphoric mood, irritability, agitation, dizziness, sensory disturbances (e.g., paresthesia, electric shock sensations), tremor, anxiety, confusion, headache, lethargy, emotional lability, insomnia, and tinnitus. 1
- Even with gradual discontinuation, some patients may still develop withdrawal symptoms, suggesting that very slow tapering is optimal. 3
Recommended Tapering Approach
- Initial reductions should be small, approximately 5-10% of the current dose, to minimize withdrawal symptoms and build patient confidence. 2
- Each new dose should be about 90% of the previous dose rather than using a straight-line taper from the starting dose. 2
- For patients on long-term trazodone therapy, slower tapers of 10% per month or even slower are more appropriate than faster tapers. 2
- The tapering process may take several months, depending on the initial dose and duration of treatment. 2
Practical Implementation Steps
- Start with very small dose reductions (around 5% of current dose) if you have previously experienced withdrawal symptoms or are anxious about tapering. 2
- For higher doses, consider tapering to 50% of the original dose before implementing the 10% reduction schedule. 2
- If withdrawal symptoms become severe during tapering, temporarily return to the previous dose and then resume tapering at a slower rate. 2
- The target dose may not necessarily be zero; some patients may benefit from continuing at a lower maintenance dose. 2
Managing Withdrawal Symptoms
- For insomnia during trazodone tapering, temporary use of alternative sleep aids may be considered. 2
- For anxiety or irritability during tapering, short-term supportive interventions may be beneficial. 2
- Close monitoring and support during the tapering process are critical to success. 2
Special Considerations
- If you are also taking benzodiazepines and need to discontinue both medications, address the benzodiazepine taper first due to the higher risks associated with benzodiazepine withdrawal. 2
- Patients with a history of mood disorders should be monitored closely during tapering as discontinuation may potentially trigger mood changes. 1
Trazodone tapering should be conducted under medical supervision, with the pace of tapering individualized based on your response to dose reductions and the emergence of any withdrawal symptoms. The evidence clearly shows that gradual tapering is safer and more comfortable than abrupt discontinuation.