Tapering Trazodone from 150mg
Gradually reduce trazodone by 50mg every 3-4 days to minimize withdrawal symptoms, following the FDA-approved dosing guidance that recommends gradual dose reduction rather than abrupt discontinuation. 1
Recommended Tapering Schedule
The FDA label explicitly states that trazodone dosage should be "gradually reduced, with subsequent adjustment depending on therapeutic response" and that you should "gradually reduce the dosage rather than stopping Trazodone Hydrochloride Tablets abruptly whenever possible." 1
Specific tapering protocol:
- Week 1-2: Reduce from 150mg to 100mg daily 1
- Week 3-4: Reduce from 100mg to 50mg daily 1
- Week 5-6: Discontinue or maintain 50mg if needed for residual symptoms 1
The FDA guidance indicates that dose adjustments of 50mg increments are appropriate, as the initial dosing recommendations suggest increasing by 50mg every 3-4 days. 1 This same increment should be used in reverse for tapering.
Critical Considerations During Taper
Monitor for discontinuation symptoms including rebound insomnia, anxiety, irritability, and mood changes, as adverse reactions may occur upon discontinuation. 1 If withdrawal symptoms emerge, slow the taper by maintaining the current dose for an additional 1-2 weeks before proceeding. 1
Trazodone has a 3-9 hour half-life, which means withdrawal symptoms can appear within 24-48 hours of dose reduction. 2 This relatively short half-life necessitates a gradual taper rather than abrupt cessation.
Why Trazodone Should Be Tapered (Not Stopped Abruptly)
Guidelines explicitly recommend against trazodone for insomnia treatment due to limited efficacy data and concerning side effects. 3 The 2020 VA/DoD guidelines state that "the low-quality evidence supporting the efficacy of trazodone was outweighed by its adverse effect profile." 3 The American Academy of Sleep Medicine found "no improvement in quality of sleep compared to placebo" despite modest improvements in sleep latency and wake after sleep onset. 3
However, abrupt discontinuation carries risks including rebound insomnia, anxiety, and potential withdrawal symptoms that can be more severe than the original insomnia. 1 Research demonstrates that tolerance can develop with trazodone use, making gradual tapering essential to avoid withdrawal phenomena. 4
Alternative Treatment During Taper
Implement Cognitive Behavioral Therapy for Insomnia (CBT-I) immediately as the patient tapers off trazodone, as CBT-I is the first-line treatment for chronic insomnia with superior long-term outcomes compared to medications. 3, 5
If pharmacotherapy remains necessary after taper completion, consider evidence-based alternatives:
- Low-dose doxepin 3-6mg for sleep maintenance (moderate-quality evidence showing 22-23 minute reduction in wake after sleep onset) 3, 5
- Ramelteon 8mg for sleep onset insomnia (no dependence risk, minimal adverse effects) 5
- Eszopiclone 2-3mg or zolpidem 10mg (5mg if elderly) as first-line benzodiazepine receptor agonists 3, 5
Common Pitfalls to Avoid
Do not stop trazodone abruptly, as this increases risk of rebound insomnia and withdrawal symptoms that may be worse than the original complaint. 1
Do not restart trazodone at full dose if withdrawal symptoms occur—instead, slow the taper by maintaining the current reduced dose for additional weeks. 1
Do not substitute another sedating medication during the taper without first implementing CBT-I, as this perpetuates medication dependence rather than addressing the underlying insomnia. 3
Do not use antihistamines (diphenhydramine) as a bridge medication, as these are explicitly not recommended due to lack of efficacy data, anticholinergic effects, and tolerance development after 3-4 days. 3