Trazodone in the elderly: risk of extrapyramidal acute events

Mayor, Joana Sotto; Pacheco, A.P.; Esperança, Sofia; Silva, Antonio Oliveira e

doi:10.1136/bcr-2015-210726

Cited by 6 publications

(3 citation statements)

References 9 publications

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“…A recent review highlighted the dearth of comparative data for older adults and suggested that low-dose trazodone should be recommended for insomnia only if the individual has comorbid depression. 23 Consensus panels on dementia treatment have also concluded that there is not clear evidence for, or against, a recommendation for use of lowdose trazodone in BPSD, 24 and low-dose trazodone use has been linked to falls 25,26 , nausea and vomiting, 23,27 and extrapyramidal symptoms 28 .…”

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confidence: 99%

Low‐Dose Trazodone, Benzodiazepines, and Fall‐Related Injuries in Nursing Homes: A Matched‐Cohort Study

Bronskill

Campitelli

Iaboni

et al. 2018

J American Geriatrics Society

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Objectives To evaluate whether risk of fall‐related injuries differs between nursing home (NH) residents newly dispensed low‐dose trazodone and those newly dispensed benzodiazepines. Design Retrospective, matched cohort study in linked, population‐based administrative data. Matching was based on propensity score ( ± 0.2 standard deviations of the score as a caliper), age ( ± 1 year), sex, frailty status, and history of dementia. The derived propensity score included demographic characteristics, clinical comorbidities, cognitive and functional status, and risk factors for falls. Setting All NHs in Ontario, Canada. Participants Propensity score–matched pairs of residents aged 66 and older who received a full clinical assessment between April 1, 2010, and March 31, 2015 (N=7,791). Measurements Hospitalization (emergency department visit or acute care admission) for a fall‐related injury within 90 days of exposure. Subdistribution hazard functions accounted for competing risk of death. Sensitivity analyses were used to examine falls resulting in hip or wrist fracture only, as well as different lengths of follow‐up at 30, 60, and 180 days. Results Cumulative incidence of a fall‐related injury in the 90 days after index was 5.7% for low‐dose trazodone users and 6.0% for benzodiazepine users (between‐group change=–0.29, 95% confidence interval (CI)=–1.02–0.44]; hazard ratio=0.94, 95% CI=0.83–1.08). Findings were consistent across sensitivity analyses. Conclusion New use of low‐dose trazodone was no safer with respect to a risk of a fall‐related injury than new use of benzodiazepines. Additional studies to compare the effectiveness and risks of low‐dose trazodone with those of a variety of psychotropic drug therapies are required in light of increasing trends in the use of trazodone in NHs.

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confidence: 99%

Low‐Dose Trazodone, Benzodiazepines, and Fall‐Related Injuries in Nursing Homes: A Matched‐Cohort Study

Bronskill

Campitelli

Iaboni

et al. 2018

J American Geriatrics Society

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“…To the authors' knowledge, there are five reports of parkinsonism secondary to trazodone in the literature. 2,[4][5][6][7] Herein, we present a case of a male who developed parkinsonism after a short-duration intake of a moderate dose of trazodone.…”

Section: Introductionmentioning

confidence: 99%

Trazodone-induced parkinsonism in a middle-aged male: A case report

Tharwat Ali,

Ashraf Soliman,

Aborigiba

et al. 2024

Afr H. Sci.

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Introduction: Trazodone is an antidepressant agent approved for treating major depressive disorders and is also prescribed forinsomnia due to its sedative effect. In a few cases, trazodone was associated with parkinsonism. Herein, we describe a case ofparkinsonism after a brief exposure to a moderate dose of trazodone. Objective: To describe a case of a patient with trazodone-induced parkinsonism in which the diagnosis was suspected after theexclusion of other common and serious causes. Methods: A case report of trazodone-induced parkinsonism. Clinical Case: A 58-year-old male with sleeping problems was prescribed trazodone 50 mg daily at bedtime. The subject doubledthe dosage without medical advice a week later. After 14 days of trazodone treatment, he started to experience difficulty inmoving his upper limbs and recurrent falling. Neuroimaging, electrodiagnostic studies, and laboratory exams were unremarkable.Trazodone was discontinued, and the patient fully recovered. Noteworthy, the patient developed a recurrence of the motorsymptoms with trazodone-rechallenge. Conclusion: Our case showed reversibly induced parkinsonism after a short intake of a moderate dose of trazodone which wasprescribed for insomnia. The patient had a complete recovery after trazodone withdrawal. Noteworthy, the symptoms recurredupon trazodone-rechallenge. Keywords: Trazodone; triazolopyridine; parkinsonism; movement disorder; drug-induced.

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“…Drugs associated with causation of EPS include the following: SSRIs like fluoxetine, paroxetine, sertraline, amisulpiride, typical antipsychotics like haloperidol, chlorpromazine, flupenthixol, fluphenazine pimozide, prochlorperazine, atypicals like clozapine, quetiapine, risperidone, sulpiride, thioridazine, trifluperazine, zuclopenthixol, and zotepine. Some other drugs that are responsible for drug-induced Parkinson's disease also include amiodarone, cinnarazine, lithium, methyldopa, metoclopramide, and trazodone [11,12] .…”

Section: Role Of Other Drugs In Causing Epsmentioning

confidence: 99%

Extrapyramidal Symptoms Probably Related to Risperidone Treatment: A Case Series

et al. 2017

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Background: Atypical antipsychotics, like risperidone purportedly, score over their typical counterparts in terms of their lower propensity toward producing extrapyramidal symptoms (EPS). However, recent studies have furnished evidence to the contrary. Hereby, we present a case series implicating risperidone as the causative agent for EPS. Methods: As a part of the pharmacovigilance programme of India, the authors have assessed 10 physician-reported cases of EPS among the 1,830 patients who were prescribed risperidone within the time period of January 2012-December 2014 in a tertiary care hospital in South India. Causality, severity, and preventability assessments of adverse reaction were done as per Naranjo's, Hartwig's, and Thornton'scale respectively. Results: Of the 10 cases, a dose-dependent occurrence of EPS was noted in all and the time duration for development of EPS ranged from 1 week to 2 years. Four patients developed EPS at a dose of 6-8 mg, 4 developed at a dose of 4-6 mg, and the remaining 2 developed at 2 and 1 mg. Conclusion: A strong temporal correlation between risperidone and EPS was noted in all cases. High doses produced EPS early, whereas moderate to low doses produced EPS at a later date. Thus, cautious use and close monitoring are warranted in the chronic use of risperidone.

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Trazodone in the elderly: risk of extrapyramidal acute events

Cited by 6 publications

References 9 publications

Low‐Dose Trazodone, Benzodiazepines, and Fall‐Related Injuries in Nursing Homes: A Matched‐Cohort Study

Low‐Dose Trazodone, Benzodiazepines, and Fall‐Related Injuries in Nursing Homes: A Matched‐Cohort Study

Trazodone-induced parkinsonism in a middle-aged male: A case report

Extrapyramidal Symptoms Probably Related to Risperidone Treatment: A Case Series

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