Risk factors for QT prolongation associated with acute psychotropic drug overdose

Miura, Naoya; Saito, Takeshi; Taira, Takayuki; Umebachi, Rimako; Inokuchi, Sadaki

doi:10.1016/j.ajem.2014.09.048

Cited by 27 publications

(11 citation statements)

References 37 publications

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“…4 It has been noted that TRZ may cause possible cardiovascular adverse effects because of the increased number of cardiotoxicity reports associated with TRZ treatment over the past years. 5,6 Studies have shown that postural hypotension, electrocardiogram (ECG) anomalies (such as prolonged PR interval, long QT syndrome), and cardiac arrhythmias were induced at therapeutic and subtherapeutic doses of TRZ. [7][8][9][10][11][12] Many drugs may cause unexpected cardiotoxic side effects in the clinical stage, even though they pass animal testing stage.…”

Section: Introductionmentioning

confidence: 99%

Assessment of trazodone-induced cardiotoxicity after repeated doses in rats

et al. 2018

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Trazodone (TRZ) is an antidepressant drug commonly used in the treatment of depression, anxiety, and insomnia. Although some studies demonstrated the adverse effects of TRZ related to cardiovascular system, the conflicting results were observed in these studies. Therefore, we aimed to investigate the cardiac adverse effects of TRZ in rats at repeated doses in our study. In accordance with this purpose, TRZ was administered orally to rats at 5, 10, and 20 mg/kg doses for 28 days. Electrocardiogram records, serum aspartate aminotransferase (AST), lactate dehydrogenase, creatine kinase-myoglobin band, cardiac troponin-T (cTn-T) levels, DNA damage in cardiomyocytes, and histologic view of heart tissues were evaluated. In addition, glutathione (GSH) and malondialdehyde (MDA) levels were measured to determine the oxidative status of cardiac tissue after TRZ administration. Heart rate was decreased, PR interval was prolonged, and QRS and T amplitudes were decreased in 20 mg/kg TRZ-administered group compared to the control group. Serum AST and cTn-T levels were significantly increased in 10 and 20 mg/kg TRZ-administered rats with respect to control rats. DNA damage was significantly increased in these groups. Additionally, degenerative histopathologic findings were observed in TRZ-administered groups. Although there was no difference in MDA levels between groups, GSH levels were significantly decreased in 10 and 20 mg/kg TRZ-administered groups compared to the control group. Our results have shown that TRZ induced cardiotoxicity in rats dose-dependently. It is assumed that oxidative stress related to GSH depletion may be accompanied by these adverse effects.

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Section: Introductionmentioning

confidence: 99%

Assessment of trazodone-induced cardiotoxicity after repeated doses in rats

et al. 2018

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“…It is also one of the most common drugs to cause priapism at around 1-10 per 10,000 patients [2]. Trazodone is rarely arrhythmogenic at therapeutic doses but can cause arrhythmias in patients with known conduction or ischemic disease [3][4][5][6][7].…”

Section: Discussionmentioning

confidence: 99%

A Case of Trazodone Overdose Successfully Rescued With Lipid Emulsion Therapy

Taylor

Burg

Mullen

2020

Cureus

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“…TSA zehirlenmelerinde risk sınıflamaları temel olarak EKG değişiklikleri ve QT uzaması ile ilgili yapılmıştır (10). TSA zehirlenmelerinde yoğun bakıma yatış gerekliliğini temel olarak EKG değişiklikleri belirler fakat alınan ilaç dozu da önemlidir, çünkü 100 ng/mL doz üzerinde QT uzaması ve epileptik nöbet ile ilişkilidir (11).…”

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Trisiklik Antidepresan Zehirlenmelerinde Adora Risk Skorlaması

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et al. 2018

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ÖZET Amaç: Trisiklik antidepresan (TSA) zehirlenmeleri ciddi klinik sonuçlara neden olabilir. TCA zehirlenmesi olan hastaların değerlendirilmesinde "Antidepresan Doz Aşımı Risk Değerlendirmesi" (ADORA) kriterleri kullanılmıştır. Bununla birlikte, bu kriterlerin morbidite ve mortalite öngörüsünde klinik yararlılığını gösteren yeterli çalışma yoktur. Bu çalışmanın amacı, ADORA kriterlerinin klinik sonuç ile ilişkisini belirlemektir. Gereç ve Yöntem: Çalışmaya 133 hasta dahil edildi. Hastalar ADORA kriterlerine göre yüksek risk ve düşük risk gruplarına ayrıldı. Bulgular: Ortanca yaş 25 (18-55 yaş aralığında) idi. Hastalar genellikle TCA ajanı olarak amitriptilin kullanmışlardır. Risk sınıflandırmasına göre; Hastaların %59.4'ü yüksek risk grubunda idi. Çalışma hastalarında en sık görülen semptom midriazis idi ve somnolans haricindeki tüm bulgular ADORA yüksek risk grubunda düşük risk grubuna göre daha fazla görülmüştü. En sık görülen bulgular sağ aks sapması ve aVR de R>S bulgusu idi. Hastaların tümü komplikasyonsuz taburcu edilmişti. ADORA pozitif risk skor sayısı arttıkça yatış süresi, QTc uzunluğu ve nöbet sıklığı artmaktaydı. Sonuç: ADORA kriterleri, TCA zehirlenmesinin değerlendirilmesi ve klinik takibinde faydalıdır. ABSTRACTObjective: Tricyclic antidepressant (TCA) poisonings can cause serious clinical outcome. The Antidepressant Overdose Risk Assessment (ADORA) criteria are used in the assessment of patients with TCA poisoning. However, the data about the benefits of these criteria in mortality and morbidity prediction in the clinical practice are insufficient. The aim of this study was to determine the relationship of ADORA criteria with clinical outcome. Methods: A total of 133 patients who admitted only with TCA poisoning at a university hospital emergency department. The patients were divided into high risk and low risk groups according to ADORA criteria. Results: The median age was 25 (range 18-55) years. Patients commonly used amitryptiline as TCA agent. According to risk classification; 59.4% of the patients were in high risk group. Most common symptom was mydriasis in study group; somnolence was more frequent in high risk group. The most common finding on electrocardiogram was the right axis deviation and the AVR was the R> S finding. The patients were discharged without any complications. As the number of ADORA positive risk scores increased, the length of hospitalization, QTc height and seizure frequency increased. Conclusion: The ADORA criteria is useful in assessment and clinical follow-up of TCA poisoning.

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Risk factors for QT prolongation associated with acute psychotropic drug overdose

Cited by 27 publications

References 37 publications

Assessment of trazodone-induced cardiotoxicity after repeated doses in rats

Assessment of trazodone-induced cardiotoxicity after repeated doses in rats

A Case of Trazodone Overdose Successfully Rescued With Lipid Emulsion Therapy

Trisiklik Antidepresan Zehirlenmelerinde Adora Risk Skorlaması

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