What is the recommended dose of Trazodone (triazolopyridine antidepressant) for insomnia?

From the Guidelines

Trazodone is not recommended for the treatment of chronic insomnia due to its adverse effect profile and low-quality evidence supporting its efficacy 1. Instead, other treatments such as cognitive-behavioral therapy for insomnia (CBT-I) and certain medications like eszopiclone, zaleplon, and zolpidem may be considered. When trazodone is used off-label for sleep, the dose range is typically between 50 to 150 mg before bedtime, but this is not a recommended treatment according to the American Academy of Sleep Medicine clinical practice guideline 1. Some key points to consider:

• Trazodone has a dose range of 50 to 150 mg before bedtime for sleep difficulties, but its use is not recommended due to adverse effects and limited evidence.
• The medication works by increasing serotonin levels in the brain and has sedative properties, but it is not a first-line treatment for insomnia.
• Common side effects may include dizziness, dry mouth, and morning drowsiness, which is why starting with a lower dose is recommended, if it were to be used.
• It's essential to take any medication only as prescribed by a healthcare provider, as individual needs vary based on medical history, other medications, and specific sleep issues.
• Regular reassessment with a doctor is crucial when using any sleep medication, including trazodone, if it were to be prescribed.

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 dose may be increased by 50 mg/day every 3 to 4 days The maximum dose for outpatients usually should not exceed 400 mg/day in divided doses.

The dose of trazodone for sleep is not explicitly stated in the label, but it can be inferred that drowsiness may be managed by administering a major portion of the daily dose at bedtime. The initial dose is 150 mg/day and may be increased by 50 mg/day every 3 to 4 days, with a maximum dose of 400 mg/day for outpatients 2.

From the Research

Trazodone Dosage for Sleep

• The effective dose of trazodone for sleep can vary, but studies suggest that a dose of 50 mg to 300 mg can be beneficial 3, 4, 5.
• A study published in 1990 found that 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.
• Another study published in 2011 used a dose of 50 mg of trazodone 30 minutes before bedtime for 7 days and found that it produced significant improvements in sleep quality 4.
• A 2008 study used a dose of 100 mg of trazodone and found that it improved sleep latency, sleep efficiency, and total sleep time when combined with cognitive behavior therapy (CBT) 5.
• More recent studies have also used trazodone doses ranging from 50 mg to 100 mg and found significant improvements in sleep quality and duration 6, 7.

Comparison of Trazodone Doses

• The optimal dose of trazodone for sleep has not been established, but doses ranging from 50 mg to 300 mg have been used in various studies 3, 4, 5, 6, 7.
• Higher doses of trazodone may be more effective for improving sleep quality, but may also increase the risk of side effects such as drowsiness and cognitive impairment 3, 4.
• Lower doses of trazodone, such as 50 mg, may be effective for improving sleep quality with fewer side effects, but may not be as effective for more severe cases of insomnia 4, 7.

Considerations for Trazodone Use

• Trazodone should be used under the guidance of a healthcare professional, as it can have side effects and interact with other medications 3, 4, 5, 6, 7.
• The dosage of trazodone should be individualized based on the patient's response to treatment and the presence of any side effects 3, 4, 5, 6, 7.
• Trazodone can be used in combination with CBT or other therapies to improve sleep quality and duration 5, 6, 7.