Can You Abruptly Stop Trazodone?
No, you should not abruptly stop trazodone—gradual dose reduction is recommended to minimize withdrawal symptoms and adverse reactions. 1
FDA-Approved Discontinuation Guidance
The FDA drug label explicitly states that trazodone should be gradually reduced rather than stopped abruptly whenever possible, as adverse reactions may occur upon discontinuation. 1 This represents the highest level of regulatory guidance for this medication.
- Gradual tapering is the standard approach: The FDA recommends reducing the dosage progressively rather than abrupt cessation to prevent discontinuation-related adverse effects. 1
- Withdrawal symptoms can occur: Patients should be advised not to abruptly discontinue trazodone and should discuss any tapering regimen with their healthcare provider. 1
Evidence for Withdrawal Symptoms
Clinical research demonstrates that trazodone withdrawal can occur even with gradual discontinuation:
- Documented withdrawal cases: Three published cases developed withdrawal symptoms despite gradual discontinuation of therapeutic doses, suggesting that trazodone's effects on the serotonergic system may result in noradrenergic rebound after stopping. 2
- Mechanism of withdrawal: The short half-life of trazodone (3-9 hours) and its active metabolite m-chlorophenylpiperazine contribute to the development of withdrawal symptoms. 2, 3
- Clinical recommendation from research: Trazodone should be tapered off at a very slow rate based on these withdrawal mechanisms. 2
Practical Tapering Approach
While specific taper schedules for trazodone are not detailed in the FDA label, general principles apply:
- Start with dose reduction: If a patient has been on trazodone for an extended period, reduce by approximately 25-50 mg every 3-7 days, monitoring for withdrawal symptoms. 1
- Slower tapers for long-term use: Patients on higher doses (300-600 mg/day) or those who have used trazodone for months to years may require more gradual reductions over several weeks. 1, 2
- Monitor for discontinuation effects: Watch for rebound insomnia, anxiety, agitation, or mood changes during the taper period. 1
Common Pitfalls to Avoid
- Don't assume benign discontinuation: Unlike some medications where abrupt cessation is safe, trazodone has documented withdrawal potential that should not be dismissed. 2
- Avoid rapid tapers in elderly patients: Older adults may be more sensitive to discontinuation effects and require even more gradual dose reductions. 4
- Don't stop suddenly if using for depression: Patients taking therapeutic antidepressant doses (150-400 mg/day) are at higher risk for withdrawal than those using low doses for sleep. 1, 3
Special Considerations
- Low-dose sleep use: Even patients using trazodone at low doses (25-100 mg) for insomnia should taper gradually, though the withdrawal risk may be lower than with antidepressant doses. 4, 3
- Rebound insomnia: Unlike benzodiazepines, trazodone does not typically cause REM rebound, but sleep disturbances can still occur with abrupt cessation. 3
- Patient education is critical: Advise patients about the importance of not stopping trazodone on their own and the need to contact their provider if they wish to discontinue. 1