Trazodone Discontinuation Guidance
Yes, you should taper trazodone gradually rather than stopping abruptly when discontinuing treatment. The FDA explicitly warns against abrupt discontinuation and recommends gradual dose reduction to minimize withdrawal reactions 1.
Why Tapering is Necessary
- Discontinuation syndrome can occur when trazodone is stopped suddenly, as the FDA specifically warns that "adverse reactions may occur upon discontinuation" 1.
- Withdrawal symptoms have been documented even with gradual discontinuation of therapeutic doses, including effects related to serotonergic system changes and noradrenergic rebound 2.
- The short half-life of trazodone (3-9 hours) and its active metabolite m-chlorophenylpiperazine contribute to withdrawal risk, making very slow tapering rates advisable 2, 3.
Recommended Tapering Approach
Gradually reduce the dosage rather than stopping abruptly whenever possible 1. While the FDA label does not specify an exact tapering schedule, the evidence suggests:
- Taper at a very slow rate based on clinical case reports showing withdrawal symptoms despite gradual discontinuation 2.
- Consider reducing by approximately 25% of the current dose every 1-2 weeks, similar to principles used for other antidepressants, though trazodone may require even slower reduction given its short half-life 2.
- Monitor closely for withdrawal symptoms during the tapering process, including anxiety, agitation, sleep disturbances, and mood changes 1.
Clinical Considerations
- Discuss any tapering regimen with your healthcare provider before making changes, as the FDA specifically advises patients not to discontinue trazodone on their own 1.
- The tapering rate should be determined by your tolerance to dose reductions, not a rigid schedule—if withdrawal symptoms emerge, slow the taper further 2.
- Once adequate response has been achieved (if used for depression), dosage may be gradually reduced with subsequent adjustment depending on therapeutic response 1.
Common Pitfall to Avoid
Never stop trazodone abruptly, even at low doses or after short-term use. The FDA's explicit warning about discontinuation syndrome applies to all patients, and case reports demonstrate that withdrawal can occur even with attempted gradual discontinuation if the taper is too rapid 1, 2.