How do I taper off trazodone (antidepressant) 350mg?

Trazodone 350mg Tapering Protocol

For a patient on trazodone 350mg, implement a slow hyperbolic taper starting with 5-10% dose reductions every 2-4 weeks, taking the medication shortly after a meal or light snack, with the tapering process likely requiring several months to minimize withdrawal symptoms. 1

Initial Tapering Strategy

Begin with small initial reductions of 5-10% of the current dose (approximately 17.5-35mg reduction from 350mg). 1 This conservative approach minimizes withdrawal symptoms and builds patient confidence in the tapering process. 1

Key Principle: Hyperbolic vs Linear Tapering

• Each new dose should be 90% of the previous dose, not a straight-line reduction from the starting dose. 1 This hyperbolic approach maintains consistent receptor occupancy changes and prevents disproportionately large reductions at lower doses. 2
• For example: 350mg → 315mg → 283mg → 255mg, rather than fixed 35mg reductions. 1

Tapering Timeline and Rate

Given the 350mg dose represents long-term therapy at a high dose, plan for a slow taper of 10% per month or slower, extending over several months. 1

• The FDA label explicitly warns against abrupt discontinuation and advises discussing any tapering regimen with the healthcare provider. 3
• Trazodone has a short 3-9 hour half-life, which increases withdrawal risk and necessitates very slow tapering. 4, 5
• Case reports document withdrawal symptoms even with gradual discontinuation, emphasizing the need for extremely slow tapers. 5

Dosing Administration During Taper

• Continue taking trazodone shortly after a meal or light snack throughout the taper. 3
• Tablets can be swallowed whole or broken in half along the score line, but should not be chewed or crushed. 3
• Consider maintaining the bedtime-weighted dosing pattern (most or all of the dose at night) as this is the established effective regimen. 4

Managing Withdrawal Symptoms

If withdrawal symptoms emerge, temporarily return to the previous dose and resume tapering at a slower rate. 1

Common Withdrawal Symptoms to Monitor:

• Somatic: dizziness, light-headedness, nausea, fatigue, myalgia, chills, flu-like symptoms, sensory disturbances, sleep disturbances. 6
• Psychological: anxiety, agitation, crying spells, irritability. 6
• These symptoms result from serotonergic effects and noradrenergic rebound after discontinuation. 5

Adjunctive Management:

• For insomnia during tapering, consider temporary use of alternative sleep aids rather than increasing trazodone. 1
• For anxiety or irritability, short-term supportive interventions may be beneficial. 1
• Reassure patients that mild symptoms are usually transient and self-limiting. 6

Important Clinical Considerations

The target dose may not necessarily be zero; some patients may benefit from continuing at a lower maintenance dose. 1 This is particularly relevant given the high starting dose of 350mg.

Monitoring Requirements:

• Close monitoring and support during the tapering process are critical to success. 1
• Watch for emergence of suicidal thoughts or behaviors, especially during dose adjustments. 3
• Monitor for activation of mania/hypomania in susceptible patients. 3
• Screen for underlying depression or anxiety that may emerge or worsen during tapering. 6

Common Pitfall to Avoid:

Do not mistake withdrawal symptoms for relapse of the underlying condition. 6 Withdrawal symptoms typically emerge within days of dose reduction and are self-limiting, while relapse develops more gradually over weeks. Misdiagnosing withdrawal as relapse leads to unnecessary reinstitution of higher doses. 6

Special Circumstances

• If the patient is also taking benzodiazepines, address the benzodiazepine taper first due to higher risks (including seizures and death) associated with benzodiazepine withdrawal. 1
• Never stop trazodone abruptly, as this significantly increases withdrawal symptom severity. 3, 5

Practical Example for 350mg Starting Dose

Month 1: Reduce to 315mg (10% reduction)
Month 2: Reduce to 283mg (10% of 315mg)
Month 3: Reduce to 255mg (10% of 283mg)
Continue pattern: Each reduction is 10% of the current dose, not the original dose 1

This approach will take approximately 6-12 months to reach very low doses, which is appropriate for long-term therapy at high doses. 1