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27 December 2019 : Case report  USA

Arrhythmias in Severe Trazodone Overdose

Rare disease

Kyaw Khaing Soe1ABCEF*, Mark Young Lee23ABCEF

DOI: 10.12659/AJCR.919833

Am J Case Rep 2019; 20:1949-1955

Abstract

BACKGROUND: Trazodone is widely used in the treatment of depression, anxiety, and insomnia. It is thought to have a safe cardiac profile due to the relative lack of anticholinergic effects. Publications about cardiac toxicities of trazodone are scant.

CASE REPORT: A 55-year-old woman presented with acute disorder of consciousness secondary to an intentional trazodone overdose. She was found to have seizure activity without cerebral edema. The initial electrocardiogram was unremarkable, with a normal QTc interval. She eventually developed QTc prolongation that evolved into ventricular tachycardia, and then into a transient right bundle-branch block, left anterior fascicular block, and variable degrees of atrioventricular nodal blocks at 12–24 h after ingestion. She then developed generalized tonic-clonic seizures, cardiogenic shock, and respiratory arrest. She was intubated and treated with antiepileptics, norepinephrine, and dopamine infusion. QTc interval prolongation gradually resolved and the various forms of heart block did not recur after at 24–36 h. She did not require transcutaneous pacing, and was successfully extubated with intact neurological function.

CONCLUSIONS: Fatal arrhythmias can occur in trazodone overdose. Close monitoring and supportive care are crucial for patient survival.

Keywords: Arrhythmias, Cardiac, atrioventricular block, Bundle-Branch Block, Drug Overdose, Long QT Syndrome, trazodone, Anti-Anxiety Agents, Anticonvulsants, Dopamine, Electrocardiography, Middle Aged, Norepinephrine, Seizures, Tachycardia, Ventricular

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923