Trazodone cardiovascular

The triazolopyridine trazodone does not have an appreciable effect on the re-uptake of the neurotrans-mittors dopamine or noradrenaline. It is a weak inhibitor of serotonin re-uptake but is a potent antagonist of the serotonin 5-HT2 receptor. Clinical experience has shown unpredictable efficacy. Trazodone has little antimuscarinic activity and has little if any action on cardiac conduction. Like mianserin it can therefore safely be used in patients for which anticholinergics are contraindicated and there are no absolute contraindications for patients with concomitant diseases of the cardiovascular system. 

The SSRis may avoid some of the more serious adverse effects seen with the TCAs. Thus, if expense is not a major concern, the SSRIs are increasingly considered an appropriate first choice (290, 291). Trazodone and bupropion are also appealing because of their milder anticholinergic and cardiovascular effects ( 292). With milder mood disturbances, a brief trial with psychostimuiants, such as methyiphenidate, can be attempted. 

Trazodone Hydrochloride Trazodone overdose causes severe toxic effects. These effects are severe if taken along with benzodiazepines or alcohol. Trazodone interacts with MAOIs, cardiovascular drugs, CNS depressants, and antiepileptics. 

Based on animal research and restricted experience in overdosage (SEDA-7, 19-21), early attempts to differentiate trazodone from tricyclic antidepressants suggested that it might be relatively free of cardiotoxic effects. However, a preliminary report of a study of the effects of trazodone on the cardiovascular system in 20 subjects mentioned two patients who had ventricular dysrhythmias (7). Others have reported ventricular tachycardia (8-10), atrial fibrillation (11), and complete heart block (12). 

Trazodone has substantially less anticholinergic activity than tricyclics, and no cardiodepres-sant actions. It thus has less of an adverse cardiovascular effect. In addition, trazodone is sedating but does not interfere with phase 4 sleep. 

B. Cardiovascular effects are usually minimal, although trazodone can cause hypotension and orthostatic hypotension, bupropion can cause sinus tachycardia, and fluoxetine may cause minor ST-T wave changes. 

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