Trazodone toxicity

Background

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

Clinical Features

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

Management

• GI decontamination
  • Activated charcoal x1
  • Gastric lavage (consider for coingestants)
• 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