trazodone overdose

1 Aug


Your next patient is a 22 yo female who was brought in for a possible overdose.  Her family states she grabbed a bottle of trazodone and downed a dozen pills before the stopped her and called EMS.  What should you be on the lookout for?


Trazodone acts by combination of serotonin reuptake inhibition and antagonism of postsynaptic serotonin type 2 (5HT-2) receptors.  (check out this previous post for a quick review of SEROTONIN SYNDROME)

Also has alpha-1 blockade, so it is associated with orthostatic hypotension – so taking near bedtime is safer. 

It also has some inhibition of central alpha adrenergic and histamine receptors causing the sedation.

Trazodone is also associated with priapism.

In 2008, of 5211 exposures where trazodone was the only substance taken there were no deaths. 

There is no established toxic dose.  Ingestions less than 2 grams are not expected to cause serious toxicity.

Metabolism is hepatic, so those with hepatic impairment may have more profound symptoms, as those with coingestions. 

Respiratory depression is more common with coingestions.

At 24 hours, symptoms are almost always resolved. 

Arrhythmias are rare but QT prolongation is possible and cardiac monitoring is initially prudent. 

ED observation for 6 hours if asymptomatic may be discharged or transferred for psychiatric admission.


Submitted by J. Stone.


References: (Tintinalli’s Emergency Medicine, Ch 172 – Atypical Antidepressants, Serotonin Reuptake Inhibitors, and Serotonin Syndrome); serotonin syndrome post; picture.


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