Arrhythmias in Severe Trazodone Overdose.

Area of Science:

• Cardiology
• Clinical Toxicology
• Pharmacology

Background:

• Trazodone is commonly prescribed for depression, anxiety, and insomnia.
• It is generally considered to have a favorable cardiac safety profile.
• Published data on trazodone-induced cardiac toxicity is limited.

Observation:

• A case report details a 55-year-old woman with trazodone overdose presenting with altered consciousness and seizures.
• Initial ECG was normal, but she later developed QTc prolongation, ventricular tachycardia, and various heart blocks.
• The patient also experienced cardiogenic shock and respiratory arrest, requiring intensive support.

Findings:

• Trazodone overdose can lead to significant cardiac complications, including fatal arrhythmias.
• QTc prolongation and complex conduction abnormalities (bundle branch blocks, AV nodal blocks) were observed.
• Successful management involved supportive care, including vasopressors and antiepileptics, without the need for pacing.

Implications:

• This case highlights the potential for severe cardiac toxicity with trazodone overdose.
• Close cardiac monitoring is critical in patients presenting with trazodone toxicity.
• Prompt and comprehensive supportive care can improve outcomes in trazodone overdose cases.