Trazodone Dosage Guide

What Is Trazodone & How Is It Used?

Trazodone is FDA-approved for adults for the treatment of major depressive disorder (MDD). Trazodone is a selective serotonin reuptake inhibitor (SSRI) and a 5HT2 receptor antagonist. Serotonin is a chemical in the brain essential for mood and happiness. SSRIs prevent the reabsorption of serotonin by cells in the brain, which makes it more available for your brain to use, leading to a better mood. Trazodone is only for adults as there is an increased risk of suicidal thoughts or behaviors found during clinical trials in children, adolescents, and young adults.^1,2

Trazodone also has off-label uses. An off-label use of a medication is a use that is not FDA-approved. Prescribers can decide to use a medication off-label because, in their professional judgment, they believe it may offer a benefit to someone. Trazodone can be used off-label for manic episodes associated with bipolar disorder (BD). When it is used in the treatment of BD, Trazodone is not meant to be used alone- it must be used with other medications.¹

Other off-label uses for trazodone include:^2,3,4

• Use as an add-on medication for the treatment of psychomotor activation (PA) (e.g. tapping, fidgeting, pacing), Preventing recurrence of depression after manic episodes in a patient with obsessive compulsive disorder (OCD)
• Insomnia (inability to sleep)
• Anxiety
• Alzheimer’s disease
• Substance abuse
• Bulimia
• Fibromyalgia
• Post-traumatic stress disorder (PTSD)

Trazodone Forms & Strengths

Trazodone is only sold in oral tablet form. These tablets are immediate-release and range from 50 mg to 300 mg in strength. Patients typically start at a lower dosage strength (75 to 150 mg). Your prescriber may increase your dose of trazodone based on your response. The dosage strength is not determined by the severity of symptoms but rather by patient factors like individual response to the medication, age, and reason for use. It is important to take trazodone as your doctor has prescribed. If there are questions about your trazodone dosage, reach out to your prescriber or pharmacist.^1,2

Trazodone is available in the United States in the following forms and strengths:

• 50 milligrams (mg) oral tablet
• 100 milligrams (mg) oral tablet
• 150 milligrams (mg) oral tablet
• 300 milligrams (mg) oral tablet

How to Take a Trazodone Dose

Trazodone should be taken with food or a light snack. It is important that you do not break, crush, or chew this medication other than breaking across a scoring line (break-line that is featured on the tablet) if indicated by your prescriber. It may be recommended to take trazodone before bed due to a common side effect of drowsiness and tiredness. It is important to avoid driving or operating heavy machinery until you know how trazodone affects you. Alcohol and medications that can cause dizziness should also be avoided due to increased drowsiness or dizziness levels when combined with trazodone.¹

Trazodone should be stored at a controlled room temperature in an air-tight and light-resistant container (typical prescription bottles are light-resistant). Do not suddenly stop taking trazodone. Gradually decreasing the dose as recommended by your prescriber or pharmacist is recommended to prevent trazodone withdrawal symptoms.¹ Talk with your prescriber or pharmacist if you wish to discontinue your trazodone prescription.

Trazodone Dosage for Adults With Manic Episodes

In limited instances, trazodone has been used to treat patients with manic episodes associated with bipolar disorder (BD). This is marked by things like an increase in energy, inflated self-esteem, extreme happiness, impulsive behavior, and psychomotor activation (PA).⁵ PA is a term describing the hyperactivity, distractibility, and restlessness that is commonly associated with hypomanic or manic episodes (e.g. fidgeting). There has been recent research to study the benefits of an injectable trazodone as well as an extended-release trazodone in mood disorders.^3,4

Here is Trazodone dosage information for adults with manic episodes associated with bipolar disorder:^3,4

• Typical starting dosage: 25-250 mg based on patient-specific factors and responses
• Dosage increases: 25-250 mg based on patient-specific factors and responses
• Maximum dosage: 250 mg based on patient-specific factors and responses

Trazodone Dosage Restrictions

Several factors go into determining the correct dose of trazodone for a patient. Individual patient response will allow the prescriber to decide how to adjust from the initial dose. The use of trazodone with kidney or liver impairment should be used with caution.¹ Use in older populations is limited in research, but antidepressants have been associated with low blood sodium levels in elderly patients.^1,2 For this reason, lower doses are recommended in elderly patients. Off-label uses of trazodone may call for different dosages. Your prescriber will decide the proper dose.²

If a patient experiences bothersome side effects with trazodone, it is common for the prescriber to decrease the dosage strength to make the medicine more tolerable for a patient. Trazodone dosage may need to be altered when taken alongside central nervous system depressants (e.g. sedatives, hypnotics), cytochrome P450 3A4 inhibitors (e.g. diltiazem, ketoconazole), digoxin, phenytoin, serotonergic drugs, or drugs affecting coagulation or bleeding.¹ Make sure your prescriber or pharmacist has a complete medication list and medical history when considering if trazodone is the correct medication for you.

What if I Miss a Trazodone Dose?

If you miss a dose of trazodone, it is important that you do not double up doses to make up for your missed dose. If you miss a dose, you can take it as soon as you remember. However, if it is close to your next dose time, take the next dose as you regularly would and skip the missed dose altogether.⁶ You may notice withdrawal effects like anxiety, agitation, and sleep disturbances if you miss your dose.¹

Patients may want to discontinue this medication during the initial stages if they experience side effects. It may take time for the body to adjust to this medication. Gradual dose increases are recommended to help the patient adjust. Patients may be tempted to discontinue trazodone once they feel symptom relief. However, providers may keep patients on this medication for extended periods of time after symptoms resolve to avoid symptom recurrence.

When discontinuing the medication, a gradual reduction of the medication should be planned with your doctor or pharmacist. This lowers the withdrawal symptoms associated with discontinuing trazodone.^1,6

You should never suddenly stop taking your medication. Talk with your healthcare provider if you would like to stop taking your medication. They will help you create a plan to taper (slowly reduce) the medication.

Can You Overdose on Trazodone?

Yes, you can overdose on trazodone. The actual amount of trazodone to overdose varies for each individual. This is why it is important to closely follow your prescriber and pharmacist’s instructions and never double up on a dose. Overdose of trazodone can be life-threatening, and you should seek immediate medical help if an overdose is suspected.^1,7

Signs of an overdose on trazodone include:^1,6,7

• Strong sedation
• Intense dizziness or fainting
• Confusion
• Nausea and vomiting
• Difficulty breathing
• Inconsistent heartbeats
• Sustained, painful erection
• Seizures

What Should You Do If You Take Too Much Trazodone?

If someone is suspected of trazodone overdose, medical attention should be sought immediately. You should call your prescriber or pharmacist or the poison control center (800-222-1222) or seek emergency medical help (911). Make a note of the medication(s) taken, dosages, and the time they were taken. Stay with the patient while you wait for help, and keep a close eye on their symptoms. A 911 operator or poison control worker may give you other directions to follow while waiting for emergency help.^1,7

Questions to Ask Your Healthcare Provider About Trazodone Dosage

If you think that trazodone could be beneficial to you, consider consulting with your doctor, therapist, psychiatrist, or pharmacist to discuss potential benefits, risks, and side effects associated with trazodone. You should provide a clear medical history and current medication list to help your doctor or pharmacist give you their best recommendation.^1,6,7

If you need to change providers for any reason, considering an online psychiatry service might be a good option for you. These services are easily accessible and convenient for patients. They can prevent delays in your mental health services and bring services you may need right to you.

Questions to ask your care team about trazodone dosage include:

• How long will it take for me to adjust to taking trazodone?
• How long does trazodone take to work?
• Am I at risk for more serious side effects if I am already taking other anxiety/depression medications?
• What’s the most effective dosage of trazodone for treating anxiety?
• Is there anything I should tell my therapist if I start to take trazodone?
• Are there any long-term side effects from taking trazodone?
• How long should I take trazodone before talking to my doctor if I do not think it is working?
• Can trazodone cause weight gain and does my dosage have anything to do with it?
• What are the most common side effects of taking trazodone?
• Will taking trazodone affect my sex life?
• Are there any dietary restrictions while taking trazodone?
• Will my insurance cover trazodone?
• When should I call my healthcare provider about the side effects of taking trazodone?
• Can I drink alcohol while taking trazodone?
• Can trazodone help with sleep problems?