Trazodone‐induced cardiac arrhythmias: a report of two cases

Winkler, Dietmar; Ortner, R.; Pjrek, Edda; Aschauer, Harald; Kasper, Siegfried

doi:10.1002/hup.746

Cited by 18 publications

(11 citation statements)

References 9 publications

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“…Even with therapeutic doses, several cases of life-threatening cardiac arrhythmias, including ventricular tachycardia [65–67] have been reported in clinical and preclinical studies [68]. Data suggest that prolongation of the QT interval is related to the interaction of trazodone with hERG potassium channels [62, 69].…”

Section: Efficacy and Tolerability Of Trazodone In Mddmentioning

confidence: 99%

Rediscovering Trazodone for the Treatment of Major Depressive Disorder

et al. 2012

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Trazodone is a triazolopyridine derivative that belongs to the class of serotonin receptor antagonists and reuptake inhibitors (SARIs). The drug is approved and marketed in several countries worldwide for the treatment of major depressive disorder (MDD) in adult patients. In clinical studies, trazodone has demonstrated comparable antidepressant activity to other drug classes, including tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs) and serotonin–noradrenaline (norepinephrine) reuptake inhibitors (SNRIs). Moreover, the SARI action of trazodone may overcome the tolerability issues that are often associated with second-generation antidepressants such as SSRIs (i.e. insomnia, anxiety and sexual dysfunction). Recent focus has been placed on the development of a new prolonged-release once-a-day formulation of trazodone (TzCOAD), which may provide improved tolerability over the conventional immediate-release formulation of trazodone. Clinical studies have led to the recent approval in the USA of TzCOAD (as Oleptro™; Angelini Labopharm LLC, Princeton, NJ, USA), which may see resurgence of interest in the drug for the management of patients with MDD. Although trazodone is approved for the treatment of depression, evidence supports the use of low-dose trazodone as an off-label hypnotic for the treatment of sleep disorders in patients with MDD. The most common adverse effects reported with trazodone are drowsiness (somnolence/sedation), headache, dizziness and dry mouth. Other events reported, albeit with low incidence, include orthostatic hypotension (particularly in elderly patients or those with heart disease), minimal anticholinergic activity, corrected QT interval prolongation and torsade de pointes, cardiac arrhythmias, and rare occurrences of priapism and suicidal ideation. Overall, trazodone is an effective and well tolerated antidepressant (SARI) with an important role in the current treatment of MDD both as monotherapy and as part of a combination strategy. Trazodone is effective in controlling a wide range of symptoms of depression, while avoiding the negative effects on sleep seen with SSRI antidepressants. The recently approved prolonged-release formulation should provide further optimization of this antidepressant and may be useful for enabling an appropriate therapeutic dose to be administered with improved patient compliance.

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Section: Efficacy and Tolerability Of Trazodone In Mddmentioning

confidence: 99%

Rediscovering Trazodone for the Treatment of Major Depressive Disorder

et al. 2012

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“…Case reports of arrhythmias have been described 84. Because of its cardiac side effects, trazodone is less desirable for use in cardiac patients.…”

Section: Cardiovascular Side-effects Of Antidepressant Drugsmentioning

confidence: 99%

Depression in vascular pathologies: the neurologist's point of view

Moretti¹,

Bernobich²,

Esposito³

et al. 2011

VHRM

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The coexistence of depression and cardiovascular disease (CVD) is regularly discussed, and much debated. There is strong evidence that there are pathophysiological mechanisms, particularly endothelial dysfunction, altered platelet aggregation, and hyperactivation of the thrombosis cascade, which coexist with hypothalamic-pituitary-adrenocortical axis dysfunction, and link depression to CVD. Therefore, depression should not be automatically considered to be a consequence of life impairment due to myocardial infarction or major stroke. Probably, it should be considered as one of the many other stressful events, or “genetic reactions to life”, which are risk factors for CVD development. This review will examine the significance of depression in clinical daily practice, its pathophysiology as a determinant in vascular events, and its real importance in, before, and after many CVD events.

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“…Compared to TCAs, selective serotonin reuptake inhibitors (SSRIs) and newer classes of antidepressants (ADs) have been suggested to have safer cardiovascular profiles ( Grimsley and Jann, 1992 ; Leonard, 1993 ; Kasper et al, 1996 ; Pacher et al, 1999 ; Ray et al, 2004 ; Fernandez et al, 2007 ; Zemrak and Kenna, 2008 ). However, an increasing number of case reports ( Friberg et al, 2006 ; Winkler et al, 2006 ; Kozian and Syrbe, 2010 ; Deshmukh et al, 2012 ) and pharmacovigilance studies ( Sadanaga et al, 2004 ; Wilting et al, 2006 ; Astrom-Lilja et al, 2008 ; Martinez et al, 2010 ) have revealed arrhythmias ( Leonard et al, 2011 ), QT interval prolongation ( Girardin et al, 2013 ; for review see Vieweg et al, 2009 ), and orthostatic hypotension during treatment with the new ADs. This has led to the ongoing discussion about their cardiovascular safety profiles ( Pacher and Kecskemeti, 2004 ).…”

Section: Introductionmentioning

confidence: 99%

Cardiovascular Adverse Reactions During Antidepressant Treatment: A Drug Surveillance Report of German-Speaking Countries Between 1993 and 2010

Spindelegger

Παπαγεωργίου

Grohmann

et al. 2014

International Journal of Neuropsychopharmacology

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Background:Antidepressants (ADs) are known to have the potential to cause various cardiovascular adverse drug reactions (ADRs). The tricyclic antidepressants (TCAs) were first revealed to be a possible source of cardiovascular ADRs. In recent years, newer classes of ADs were also suggested to have a higher risk of cardiovascular adverse effects. In particular, the selective serotonin reuptake inhibitors (SSRIs) were suspected to have the potential to induce QTc interval prolongation, and therefore increase the risk of ventricular arrhythmia. This descriptive study is based on the continuous pharmacovigilance program of German-speaking countries (Austria, Germany, and Switzerland), the Arzneimittelsicherheit in der Psychiatrie (AMSP), which assesses severe ADRs occurring in clinical routine situations.Methods:Of 169 278 psychiatric inpatients treated with ADs between 1993 and 2010, 198 cases of cardiovascular ADRs (0.12%) were analyzed.Results:Our study showed that the incidence rates of cardiovascular ADRs were highest during treatment with monoamine oxidase inhibitors (0.27%), TCAs (0.15%), and serotonin noradrenaline reuptake inhibitors (0.14%); the risk of occurring during treatment with SSRIs (0.08%) was significantly lower. The noradrenergic and specific serotonergic AD mirtazapine (0.07%) had a significantly lower risk of cardiovascular ADRs than all other ADs. Severe hypotension was the most frequent ADR, followed by hypertension, arrhythmia, and in some rare cases heart failure.Conclusions:Despite certain limitations due to the AMSP study design, our observations on cardiovascular ADRs can contribute to a better knowledge of the cardiovascular risk profiles of antidepressants in the clinical routine setting. However, prospective studies are needed to verify our findings.

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Trazodone‐induced cardiac arrhythmias: a report of two cases

Cited by 18 publications

References 9 publications

Rediscovering Trazodone for the Treatment of Major Depressive Disorder

Rediscovering Trazodone for the Treatment of Major Depressive Disorder

Depression in vascular pathologies: the neurologist's point of view

Cardiovascular Adverse Reactions During Antidepressant Treatment: A Drug Surveillance Report of German-Speaking Countries Between 1993 and 2010

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