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Trazodone-induced parkinsonism: A case report.

Kanishk Deep Sharma, Tony Colangelo, Aaron Mills

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    Trazodone, used for insomnia, may cause parkinsonism in older adults. This case highlights the risk of drug interactions and adverse effects, emphasizing careful medication management in the elderly.

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    Area of Science:

    • Geriatric Medicine
    • Pharmacology
    • Neurology

    Background:

    • Trazodone is frequently prescribed off-label for insomnia in older adults.
    • At low doses, trazodone acts as a histamine-1 (H1) receptor antagonist, producing a hypnotic effect.
    • Potential severe side effects include suicidal behavior, excessive sedation, QT prolongation, and priapism.

    Observation:

    • A 78-year-old male with multiple comorbidities developed tremors, rigidity, and gait disturbance after starting trazodone for insomnia.
    • The patient presented with coarse tremors, difficulty writing, and a shuffling gait with foot-dragging.
    • Clinical examination revealed bilateral cogwheel rigidity and an unsteady gait, indicative of parkinsonism.

    Findings:

    • Trazodone was identified as the likely cause of parkinsonism in this patient.
    • Concurrent amiodarone use may have impaired trazodone metabolism, potentially increasing its blood levels.
    • The serotonin-dopamine system interaction is a significant proposed mechanism for trazodone-induced parkinsonism.

    Implications:

    • This case underscores the importance of considering trazodone-induced parkinsonism, especially in elderly patients with polypharmacy.
    • Physicians must carefully weigh the benefits against the potential risks of trazodone and other medications in older adults.
    • Polypharmacy can exacerbate drug adverse effects, necessitating vigilant monitoring and medication review in geriatric patients.