What is the ideal dose of trazodone (Trazodone hydrochloride) for insomnia?

From the Guidelines

The ideal dose of trazodone for sleep is not recommended due to its adverse effect profile outweighing its benefits, as stated in the 2020 Annals of Internal Medicine study 1. Instead, the work group advised against use of benzodiazepines or trazodone for treatment of chronic insomnia disorder, and recommended nonpharmacologic behavioral interventions, such as cognitive behavioral therapy for insomnia (CBT-I), as the first-line treatment. Some key points to consider:

• Trazodone is actually an antidepressant that is often prescribed off-label for insomnia due to its sedating properties.
• The dose for sleep is much lower than when used for depression (which typically ranges from 150-400 mg daily).
• Common side effects may include morning drowsiness, dizziness, dry mouth, and headache.
• Always consult with a healthcare provider before starting any medication, especially if you take other medications, as it can interact with certain drugs and may not be appropriate for everyone.
• The potential benefits of CBT-I outweigh the potential harms and burden of pharmacotherapy given that there are fewer adverse effects. Some alternative treatment options for insomnia include:
• Low-dose doxepin (1,3, and 6 mg)
• Nonbenzodiazepine benzodiazepine receptor agonists (BZRAs)
• CBT-I It's essential to consult with a healthcare provider to determine the best course of treatment for insomnia, as they can help you weigh the potential benefits and risks of each option and develop a personalized treatment plan.

From the FDA Drug Label

1. Dosage and Administration 2. 1 Dose Selection An initial dose of 150 mg/day in divided doses is suggested. The dosage should be initiated at a low-dose and increased gradually, noting the clinical response and any evidence of intolerance. Occurrence of drowsiness may require the administration of a major portion of the daily dose at bedtime or a reduction of dosage.

The ideal dose of trazodone for sleep is not explicitly stated in the drug label. However, it is suggested that drowsiness may require the administration of a major portion of the daily dose at bedtime. The initial dose is suggested to be 150 mg/day in divided doses, and the dosage may be increased by 50 mg/day every 3 to 4 days. Key points to consider:

• Initial dose: 150 mg/day
• Dose increase: 50 mg/day every 3 to 4 days
• Administration: major portion of the daily dose at bedtime if drowsiness occurs 2

From the Research

Ideal Dose of Trazodone for Sleep

• The ideal dose of trazodone for sleep is a topic of discussion in several studies 3, 4, 5, 6.
• According to a 1990 study, trazodone is best dosed at 150 mg given predominantly at bedtime and increased as needed to 200 to 300 mg for full antidepressant efficacy 3.
• A 1999 dose-finding study found that trazodone at a dosage of 50-100 mg/day improved sleep disorders, particularly at the 100 mg/day dosage 4.
• Another study in 2008 found that 100mg of trazodone combined with cognitive behavior therapy (CBT) significantly increased slow wave sleep duration in patients with primary insomnia 5.
• A 2020 preliminary study found that trazodone significantly lengthened total sleep time in patients with insomnia with short sleep duration phenotype, with no significant differences in insomnia severity index scores between the trazodone and CBT-I groups 6.

Comparison with Cognitive Behavioral Therapy

• A 2012 systematic review found that cognitive behavioral therapy for insomnia (CBT-I) has superior effectiveness to benzodiazepine and non-benzodiazepine drugs in the long term, while benzodiazepines are more effective in the short term 7.
• The same review found that CBT-I is effective for treating insomnia when compared with medications, and its effects may be more durable than medications 7.