What is the best tapering schedule for a adult patient with no significant medical history, who has been taking trazodone (antidepressant medication) 150 mg for approximately 2 months and now wants to discontinue?

Trazodone Tapering After 2 Months at 150 mg

For a patient on trazodone 150 mg for 2 months, gradually reduce the dosage rather than stopping abruptly, decreasing by 50 mg every 3-7 days until discontinuation is complete. 1

Recommended Tapering Schedule

The FDA label explicitly states to "gradually reduce the dosage rather than stopping Trazodone abruptly whenever possible" to minimize adverse reactions upon discontinuation. 1 Given the 2-month duration of use at 150 mg, a straightforward taper is appropriate:

• Week 1-2: Reduce to 100 mg daily 1
• Week 3-4: Reduce to 50 mg daily 1
• Week 5: Discontinue completely 1

Alternatively, a more conservative approach with 50 mg reductions every 3-4 days can be used, which aligns with the FDA's dosage adjustment guidance. 1

Rationale for This Approach

The relatively short duration of use (2 months) and moderate dose (150 mg) allows for a faster taper compared to long-term benzodiazepine discontinuation protocols. 2 The FDA guidance for antidepressants generally recommends discontinuing over 10-14 days to limit withdrawal symptoms. 2

Trazodone has a short elimination half-life of 3-9 hours, which necessitates careful tapering despite the brief treatment duration. 3, 4 Research has documented that withdrawal symptoms can develop even with gradual discontinuation of therapeutic doses, and these symptoms are attributed to trazodone's effects on the serotonergic system and its short half-life. 5

Monitoring During Taper

Monitor for withdrawal symptoms at each dose reduction, including: 6

• Anxiety or agitation 6
• Insomnia or sleep disturbances 6
• Mood changes 6
• Physical symptoms (headache, dizziness, nausea) 6

If significant withdrawal symptoms emerge, extend the time at the current dose before proceeding to the next reduction. 6

Critical Safety Considerations

The FDA explicitly warns that "adverse reactions may occur upon discontinuation" and emphasizes gradual dose reduction. 1 Patients should be advised not to abruptly discontinue trazodone and to discuss the tapering regimen with their healthcare provider. 1

Administer trazodone shortly after a meal or light snack during the taper to maintain consistent absorption. 1

Common Pitfalls to Avoid

• Never stop trazodone abruptly - this increases the risk of withdrawal symptoms 1
• Do not taper too quickly - research suggests trazodone should be tapered at a "very slow rate" in some patients 5
• Failing to monitor for symptom recurrence during and after the taper 6
• Not having a contingency plan if withdrawal symptoms become significant - be prepared to slow the taper or temporarily increase the dose 6

When to Slow the Taper

If the patient experiences significant withdrawal symptoms at any point, consider:

• Returning to the previous dose and maintaining it for 1-2 additional weeks 6
• Reducing subsequent decrements to 25 mg instead of 50 mg 1
• Extending the interval between dose reductions to 7-10 days 2

The goal is successful discontinuation with minimal distress, not speed of taper. 6