Trazodone Titration Plan Starting at 100 mg
If you are starting trazodone at 100 mg, increase the dose by increments of the initial dose (100 mg) every 5-7 days until therapeutic benefits appear or significant side effects develop, with a target range of 150-300 mg for full antidepressant efficacy. 1, 2
Initial Dosing Strategy
- Starting at 100 mg is higher than the typical initial dose of 25 mg recommended in guidelines, but this approach is supported when more rapid titration is clinically appropriate 1, 3
- Administer the dose predominantly or entirely at bedtime to maximize sleep benefits and minimize daytime drowsiness 2, 4
- Taking trazodone after meals can reduce untoward side effects 5
Titration Schedule
- Increase by 100 mg increments every 5-7 days based on the general principle that dosage increases should use increments of the initial dose 1
- Target dose for antidepressant efficacy: 150-300 mg daily 2, 6
- Maximum dose: 200-400 mg per day when used for mood stabilization or antiagitation 1, 3
Specific Titration Steps from 100 mg:
- Week 1: 100 mg at bedtime
- Week 2: 200 mg at bedtime (if tolerated and response inadequate)
- Week 3: 300 mg at bedtime (if needed for full therapeutic effect)
- Consider 400 mg only if 300 mg provides insufficient response 1, 6
Important Clinical Considerations
Dosing schedule matters: Single nighttime dosing produces equal antidepressant efficacy compared to divided daily doses, but with better sleep promotion and less daytime drowsiness, especially during treatment onset 2, 4
Avoid excessive doses: Studies using high starting doses (200 mg/day) with rapid titration to 600 mg/day reported poorer therapeutic responses than those using more conservative dosing 5
Duration of adequate trial: Allow at least 4-8 weeks at the therapeutic dose before concluding treatment failure 1, 3
Safety Monitoring
- Use with caution in patients with premature ventricular contractions 1, 3
- Monitor for orthostatic hypotension, particularly during initial titration 1
- Watch for excessive sedation, which is the most common side effect 2
- Be aware of rare but serious risk of priapism 5
Reassessment
After 9 months of treatment, consider dosage reduction to reassess the need for continued medication 1, 3
When discontinuing, taper over 10-14 days to limit withdrawal symptoms 1