Trazodone Discontinuation Taper Schedule for Adults
Gradual tapering is recommended when stopping trazodone to reduce risk of discontinuation symptoms. [2][3]
Published guidance does not provide a trazodone-specific, single “recommended” taper schedule. [1][3]
Medication Discontinuation Principles
- Tapering should be gradual rather than abrupt. [2][3]
- Dose reductions are commonly implemented as approximately 10% to 25% decrements at intervals of one to several weeks. [1]
- Taper duration should be extended toward several weeks to months depending on symptoms and risk for discontinuation symptoms. [2][3]
Medication Selection Algorithm (Taper-Rate Framework)
- If discontinuation symptoms emerge after a dose reduction, the last effective dose should be reinstated and the taper should be slowed. [2][3]
- If no discontinuation symptoms emerge, dose reductions can proceed at the next scheduled step (generally every one to two weeks for standard deprescribing rates). [1][3]
Example Taper Schedule From 150 mg Daily (No Significant Comorbidities)
The following schedule is an example using the common deprescribing rate of ~10% to 25% reductions every one to two weeks. [1][3]
- Week 0 to 1: 150 mg daily [1][3]
- Week 1 to 2: 125 mg daily (25 mg reduction) [1][3]
- Week 2 to 3: 100 mg daily (25 mg reduction) [1][3]
- Week 3 to 4: 75 mg daily (25 mg reduction) [1][3]
- Week 4 to 5: 50 mg daily (25 mg reduction) [1][3]
- Week 5 to 6: 25 mg daily (25 mg reduction) then stop at end of Week 6 if tolerated [1][3]
Monotherapy vs Combination Therapy Considerations
- If tapering is occurring for insomnia treated with trazodone, discontinuation should be paired with ongoing insomnia management to reduce recurrence risk. [1]
- If trazodone is being used for depression, recurrence risk should be monitored during tapering, and taper speed should be adjusted based on emergent symptoms. [2][3]
Initiation Thresholds for Slowing or Extending the Taper
- The taper should be slowed when discontinuation symptoms occur after a dose decrease. [2][3]
- Dose reduction intervals should be lengthened toward longer tapers when symptoms are sensitive to reductions. [2][3]
Common Pitfalls to Avoid
- Abrupt discontinuation should be avoided because it increases the likelihood of antidepressant discontinuation symptoms. [2][3]
- Overly fast tapers increase the probability of emerging symptoms, which often requires returning to the prior dose and resuming a slower taper. [2][3]
Target Goals of Therapy During Tapering
- The goal is complete discontinuation with minimal discontinuation symptoms and no emergence of significant depressive symptoms or insomnia relapse. [2][3]
Suggested Monitoring During the Taper
- Monitoring should occur after each dose step for discontinuation symptoms and return of the target condition for which trazodone was used. [2][3]
- Clinical reassessment should be performed if symptoms emerge, with taper adjustment based on the observed response. [2][3]