Trazodone Use and Dosing Considerations

Off-Label Use for Insomnia

• The American Academy of Sleep Medicine explicitly recommends against using trazodone for either sleep onset or sleep maintenance insomnia, as the studied dose of 50 mg showed no clinically significant benefit 1, 2, 3
• At 50 mg, trazodone reduced sleep latency by only 10.2 minutes, increased total sleep time by 21.8 minutes, and reduced wake after sleep onset by 7.7 minutes, all of which are below clinical significance thresholds 1, 2, 3
• Sleep quality showed no significant improvement versus placebo, and harms potentially outweigh benefits, with 75% of subjects experiencing adverse events versus 65.4% on placebo 1, 2
• The most common adverse events were headache (30% vs 19%) and somnolence (23% vs 8%) 1, 2

Off-Label Use for Nightmares in PTSD

• A retrospective study found a mean effective dose of 212 mg/day for reducing nightmare frequency in PTSD patients, but 60% experienced side effects and 19% discontinued due to intolerable adverse effects 4, 5

Special Populations

• Elderly patients should use trazodone with caution due to increased risk of orthostatic hypotension, falls, and daytime drowsiness, with maximum tolerated doses typically 300-400 mg/day 3