What is the recommended dosing for trazodone (an antidepressant medication)?

Trazodone Dosing Recommendations

For depression treatment, trazodone should be initiated at 150 mg/day in divided doses, with gradual increases of 50 mg every 3-4 days as needed, with a maximum dose of 400 mg/day for outpatients and 600 mg/day for inpatients. 1

Dosing for Depression

Initial Dosing and Titration

• Start with 150 mg/day in divided doses 1
• Increase gradually by 50 mg/day every 3-4 days based on clinical response and tolerance 1
• Maximum dose for outpatients: 400 mg/day in divided doses 1
• Maximum dose for inpatients (more severely depressed): up to 600 mg/day in divided doses 1

Administration Recommendations

• Take shortly after a meal or light snack 1
• Can be swallowed whole or administered as a half tablet by breaking along the score line 1
• Consider administering a major portion of the daily dose at bedtime if drowsiness occurs 1, 2
• Single nighttime dosing may improve sleep with less daytime drowsiness compared to multiple daily dosing 2

Special Populations

Elderly Patients

• Maximum tolerated doses in elderly: 300-400 mg/day 3
• Lower starting doses may be appropriate due to increased risk of side effects 3
• Monitor closely for orthostatic hypotension in elderly patients 3, 4
• Risk of extrapyramidal events has been reported even with low doses in elderly patients 4

Dosing for Other Indications

For Insomnia/Sleep Disorders

• When used specifically for insomnia, lower doses (25-50 mg) are typically employed 5
• Initial dose: 25 mg per day 6
• Maximum: 200-400 mg per day in divided doses when used as a mood-stabilizing/antiagitation drug 6
• Note: The American Academy of Sleep Medicine recommends against using trazodone for sleep onset or maintenance insomnia in adults 5

Drug Interactions and Dosage Adjustments

• Consider reducing trazodone dose when coadministered with strong CYP3A4 inhibitors 1
• Consider increasing trazodone dose when coadministered with strong CYP3A4 inducers 1
• At least 14 days must elapse between discontinuation of a monoamine oxidase inhibitor (MAOI) and initiation of trazodone 1

Discontinuation

• Gradually reduce the dosage rather than stopping trazodone abruptly to minimize withdrawal symptoms 1
• Adverse reactions may occur upon discontinuation of trazodone 1

Monitoring and Safety Considerations

• Use with caution in patients with premature ventricular contractions 6
• Monitor for orthostatic hypotension, arrhythmias, and priapism 3
• Screen for bipolar disorder prior to starting trazodone 1
• Common side effects include drowsiness, sedation, and dizziness 3, 7
• Trazodone has a lower incidence of anticholinergic side effects, weight gain, and sexual side effects compared to many other antidepressants 7, 8

Efficacy Considerations

• A full therapeutic trial requires at least 4-8 weeks 6
• Dosage increases should use increments of initial dose every 5-7 days until therapeutic benefits or significant side effects become apparent 6
• After 9 months, consider dosage reduction to reassess the need for medication 6