Trazodone toxicity

Background

Trazodone is extremely safe in overdose as long as there are no coingestants
Has serotonergic and α blocking effects

Clinical Features

CNS depression
- Most common symptom
- Rarely produces coma or seizures when it is the only drug ingested
Respiratory depression
- Fairly common (but only with coingestants)
Orthostatic hypotension
QT prolongation

Differential Diagnosis

Sedative/hypnotic toxicity

Evaluation

Clinical diagnosis, assess for alternate etiologies

Management

Supportive care
Activated charcoal and gastric lavage are not indicated
QT prolongation
- Treat torsades in usual manner
Hypotension
- IVF
- Norepinephrine
  - Dopamine is contraindicated

Disposition

Consider discharge for patients who remain asymptomatic for at least 6 hours

References

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