What is the typical dosing frequency of Trazodone (antidepressant medication)?

Trazodone Dosing Frequency

Trazodone is typically administered once daily at bedtime, though the FDA-approved regimen for depression specifies divided doses throughout the day starting at 150 mg/day in divided doses. 1

Standard Dosing Frequency by Indication

For Depression (FDA-Approved)

• Initial dosing: 150 mg/day in divided doses 1
• Titration: Increase by 50 mg/day every 3-4 days based on clinical response 1
• Outpatient maximum: 400 mg/day in divided doses 1
• Inpatient maximum: 600 mg/day in divided doses (for severely depressed patients) 1
• The American Academy of Family Physicians recommends starting at 100 mg and increasing by 100 mg increments every 5-7 days, targeting 150-300 mg for full antidepressant efficacy 2

For Insomnia/Sleep Disorders (Off-Label)

• Once-daily dosing at bedtime is preferred and equally effective 3, 4
• Initial dose: 25-50 mg at bedtime 2
• Effective dose range: 50-100 mg at bedtime, with 100 mg showing superior efficacy for sleep disorders 4
• Maximum for sleep: 200-400 mg/day when used for mood stabilization 2

For PTSD-Related Nightmares

• Once-daily dosing at bedtime 5
• Mean effective dose: 212 mg/day (administered at bedtime) 5

Clinical Rationale for Dosing Frequency

Single bedtime dosing is pharmacologically sound and clinically superior for most patients due to:

• Trazodone's 3-9 hour half-life supports once-daily dosing 3
• Sedation as the primary side effect is better tolerated when concentrated at bedtime 3, 6
• Studies demonstrate equal antidepressant efficacy between single nighttime dosing versus divided daily doses 3
• Single bedtime dosing produces better sleep with less daytime drowsiness, particularly during treatment initiation 3

Important Administration Considerations

Timing with Food

• Always administer shortly after a meal or light snack to optimize absorption and reduce side effects 1, 6
• Food delays absorption and reduces peak concentration but does not affect total drug exposure 7

Dose Adjustments

• If drowsiness is problematic, administer the major portion of the daily dose at bedtime or reduce total dosage 1
• For divided dosing regimens, weight the dose toward bedtime 3

Treatment Duration and Monitoring

• Allow 4-8 weeks at therapeutic dose before concluding treatment failure 2
• After 9 months of treatment, consider dosage reduction to reassess medication necessity 2
• When discontinuing, taper over 10-14 days to limit withdrawal symptoms 2

Common Pitfalls to Avoid

• Avoid excessively rapid titration: Studies using high starting doses (200 mg/day) and rapid escalation to 600 mg/day reported poorer therapeutic responses than conservative dosing strategies 6
• Don't overlook the sedation profile: 60% of patients continuing trazodone experience side effects, particularly daytime sedation or dizziness 5
• Monitor for serious adverse effects: Priapism occurred in 5 of 74 patients in one cohort, requiring treatment discontinuation 5
• Use caution in patients with premature ventricular contractions and monitor for orthostatic hypotension during titration 2