Trazodone Dosing for Antidepressant Treatment
For antidepressant treatment, trazodone should be initiated at 150 mg/day in divided doses and gradually increased based on clinical response, with a maximum outpatient dose of 400 mg/day and inpatient dose of 600 mg/day. 1
Initial Dosing and Titration
- Start with 150 mg/day in divided doses 1
- Increase by 50 mg/day every 3-4 days as needed based on clinical response and tolerability 1
- Take shortly after a meal or light snack to improve absorption 1
- Can be swallowed whole or administered as a half tablet by breaking along the score line 1
Maximum Dosing
- Outpatients: Maximum dose should not exceed 400 mg/day in divided doses 1
- Inpatients (more severely depressed patients): Up to 600 mg/day in divided doses 1
- Elderly patients: Maximum tolerated doses are typically 300-400 mg/day 2
Administration Schedule Options
- Traditional divided dosing: Multiple doses throughout the day 3
- Single nighttime dosing: Studies show equal efficacy for depression relief when given predominantly at bedtime 3
- Bedtime-weighted dosing: 150 mg given predominantly at bedtime, increased as needed to 200-300 mg for full antidepressant efficacy 3
- Consider administering a major portion of the daily dose at bedtime if drowsiness occurs 1
Duration of Treatment
- A full therapeutic trial requires at least 4-8 weeks 4
- Dosage should be increased using increments of initial dose every 5-7 days until therapeutic benefits or significant side effects become apparent 4
- Once an adequate response has been achieved, dosage may be gradually reduced, with subsequent adjustment depending on therapeutic response 1
Special Considerations
Screening and Monitoring
- Screen patients for personal or family history of bipolar disorder, mania, or hypomania prior to initiating treatment 1
- After 9 months, consider dosage reduction to reassess the need for medication 4
Drug Interactions
- At least 14 days must elapse between discontinuation of a monoamine oxidase inhibitor (MAOI) and initiation of trazodone 1
- Consider reducing trazodone dose when coadministered with strong CYP3A4 inhibitors 1
- Consider increasing trazodone dose when coadministered with strong CYP3A4 inducers 1
Discontinuation
- Gradually reduce the dosage rather than stopping trazodone abruptly to avoid discontinuation symptoms 1
- Discontinuing trazodone over 10-14 days limits withdrawal symptoms 4
Side Effects and Precautions
- Most common side effect is sedation/drowsiness 3, 5
- Other potential side effects include dizziness, gastrointestinal dysfunction, and dry mouth 5
- Monitor for orthostatic hypotension, especially in elderly patients 2
- Use with caution in patients with premature ventricular contractions 4
- Priapism has been reported as a rare but serious side effect 2
Efficacy Profile
- Trazodone has been shown to be as effective as other antidepressants including amitriptyline, imipramine, fluoxetine, and mianserin in relieving depressive symptoms 2
- Particularly beneficial for patients with depression accompanied by anxiety and insomnia due to its sedative properties 6
- May be helpful for patients who are unresponsive to or cannot tolerate therapy with other antidepressants 2
Special Populations
- Elderly patients may benefit from lower starting doses and slower titration 5
- Has been successfully used in patients with depression and pre-existing cardiovascular disease 2
- Has lower incidence of anticholinergic and cardiovascular effects compared to older tricyclic antidepressants in elderly patients 2