What is the recommended tapering schedule for an adult patient with no significant medical history taking trazodone (antidepressant) 150 mg?

Tapering Off Trazodone 150 mg

Gradually reduce trazodone by 50 mg every 3-4 days, or more conservatively by 25-50 mg every 1-2 weeks, rather than stopping abruptly. 1

FDA-Recommended Discontinuation Approach

The FDA label explicitly states that adverse reactions may occur upon discontinuation of trazodone, and recommends gradually reducing the dosage rather than stopping abruptly whenever possible. 1 While the label does not specify an exact tapering schedule, it suggests initiating at low doses and adjusting by 50 mg/day every 3-4 days during titration, which can be applied in reverse for discontinuation. 1

Recommended Tapering Protocol

For a patient on 150 mg daily, consider the following approach:

• Week 1-2: Reduce to 100 mg daily (33% reduction) 1
• Week 3-4: Reduce to 50 mg daily (50% reduction from current dose) 1
• Week 5-6: Reduce to 25 mg daily or 50 mg every other day 1
• Week 7: Discontinue completely 1

This conservative 6-7 week taper minimizes withdrawal symptoms while being practical for outpatient management. 1 Some patients may tolerate faster tapers (reducing by 50 mg every 3-4 days as per FDA guidance), while others with prolonged use may require slower reductions. 1

Timing and Administration Considerations

Trazodone should be taken shortly after a meal or light snack, and the dose is typically weighted toward bedtime due to its sedative effects. 1, 2 The 3-9 hour half-life of trazodone supports once-daily dosing at bedtime, which produces better sleep with less daytime drowsiness. 2

When tapering, maintain the bedtime dosing schedule and reduce the total daily dose gradually. 1, 2 Trazodone tablets can be broken along the score line to facilitate dose reductions. 1

Monitoring for Withdrawal Symptoms

Watch for the following during the taper:

• Sleep disturbances or rebound insomnia 2, 3
• Increased anxiety or mood changes 3
• Nausea or gastrointestinal symptoms 3
• Headache or dizziness 3

Unlike benzodiazepines, trazodone does not cause tolerance or rapid eye movement rebound on discontinuation, making withdrawal generally milder. 2 However, gradual tapering is still recommended to minimize any discontinuation effects. 1

Important Clinical Context

Trazodone is NOT recommended as a primary treatment for chronic insomnia. The American Academy of Sleep Medicine found that trazodone (at 50 mg doses) showed only minimal improvements in sleep latency (10 minutes) and wake after sleep onset (8 minutes) compared to placebo, with no improvement in quality of sleep. 4 Similarly, the VA/DoD guidelines advise against using trazodone for chronic insomnia disorder due to low-quality evidence supporting its efficacy being outweighed by its adverse effect profile. 4

Special Situations

If the patient was using trazodone off-label for insomnia rather than depression:

Consider implementing cognitive-behavioral therapy for insomnia (CBT-I) or sleep hygiene education during the taper, rather than substituting another sleep medication. 4 The evidence shows that trazodone's sedative effects do not translate to meaningful improvements in objective sleep quality. 4

If the patient is also taking benzodiazepines:

Trazodone has been studied as an adjunct during benzodiazepine discontinuation. Research shows that trazodone 300 mg daily can help maintain patients off benzodiazepines during a taper, though it does not significantly reduce withdrawal severity. 5, 6 In one study, 67% of patients remained benzodiazepine-free at 5 weeks when using trazodone as an adjunct. 6

Common Pitfalls to Avoid

• Never stop trazodone abruptly - the FDA explicitly warns against this approach. 1
• Do not substitute another sedating medication (like benzodiazepines or Z-drugs) for sleep complaints during the taper, as these carry their own risks and do not address the underlying issue. 4
• Do not continue trazodone long-term for insomnia - if sleep was the primary indication, address this with evidence-based non-pharmacologic approaches. 4

Realistic Expectations

Most patients tolerate trazodone discontinuation well when tapered gradually over 4-7 weeks. 1, 2 The most commonly reported side effects during trazodone use are sedation, tiredness, dry mouth, nausea, and dizziness - these should improve during the taper. 3 Unlike benzodiazepines, trazodone does not cause physical dependence or severe withdrawal syndromes. 2