Trazodone Dosing Regimen
For Betty, trazodone should be initiated at 25-50 mg at bedtime, with gradual titration as needed up to 100 mg for insomnia or 150-400 mg in divided doses for depression, taken shortly after a meal or light snack. 1
Initial Dosing
- For insomnia: Start with 25-50 mg taken as a single dose at bedtime 2, 3
- For depression: Initial dose of 150 mg/day in divided doses, with a major portion administered at bedtime 1
- Trazodone should be taken shortly after a meal or light snack to improve absorption and tolerance 1
- Elderly patients should start at lower doses (25 mg) due to increased sensitivity to side effects 4, 5
Titration Schedule
- Increase dose gradually by 50 mg every 3-4 days based on clinical response and tolerability 1
- For insomnia: Titrate to effective dose, typically 50-100 mg at bedtime 4, 3
- For depression: Titrate to 150-400 mg/day in divided doses, with the larger portion at bedtime 1, 2
- Maximum dose for outpatients should not exceed 400 mg/day 1
Administration Options
- Single bedtime dosing is preferred for insomnia and has shown equal efficacy to multiple daily dosing for depression 2
- Can be swallowed whole or administered as a half tablet by breaking along the score line 1
- For depression requiring doses above 100 mg, consider divided dosing with the larger portion at bedtime to minimize daytime drowsiness 1, 2
Monitoring and Adjustments
- Assess for drowsiness, which may require administering a major portion of the daily dose at bedtime or reducing the dosage 1
- Once an adequate response has been achieved, dosage may be gradually reduced with subsequent adjustments based on therapeutic response 1
- Monitor for orthostatic hypotension, particularly in elderly patients 5
Special Considerations
- The American Academy of Sleep Medicine does not recommend trazodone as first-line treatment for primary insomnia 6
- For elderly patients, maximum tolerated doses are typically 300-400 mg/day 5
- When discontinuing treatment, gradually reduce the dosage rather than stopping abruptly to avoid discontinuation symptoms 1
Common Pitfalls to Avoid
- Starting with too high a dose, which increases risk of side effects, particularly sedation 4
- Failing to take with food, which can increase side effects 1
- Abrupt discontinuation, which may lead to withdrawal symptoms 1
- Using for primary insomnia without comorbid depression or anxiety, which is not supported by guidelines 6