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

• Absinthe
• Barbiturates
• Benzodiazepines
  • Flunitrazepam (Rohypnol)
• Chloral hydrate
• Gamma hydroxybutyrate (GHB)
• Baclofen toxicity
• Opioids
  • Lomotil toxicity
  • Loperamide toxicity
• Toxic alcohols
  • Ethanol
  • Ethylene glycol
  • Isopropyl alcohol
  • Methanol
• Xylazine 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