What is the treatment for trazodone (antidepressant medication) overdose or over sedation?

From the Guidelines

Treatment for trazodone overdose or over-sedation requires immediate medical attention, with a focus on supportive care, including monitoring vital signs, ensuring adequate breathing, and maintaining fluid balance, as well as managing potential complications such as hypotension, QT prolongation, and arrhythmias. The first step in managing a trazodone overdose is to call poison control or emergency services right away. At the hospital, treatment typically involves:

• Monitoring vital signs and ensuring adequate breathing
• Maintaining fluid balance
• Administering activated charcoal if the overdose was recent (within 1-2 hours) to reduce drug absorption
• Managing complications like hypotension with IV fluids or vasopressors such as norepinephrine
• Cardiac monitoring due to the risk of QT prolongation and arrhythmias, as noted in studies such as 1
• Treating seizures with benzodiazepines like diazepam or lorazepam There is no specific antidote for trazodone overdose, and the medication's half-life of 5-9 hours necessitates monitoring for at least 24 hours. Trazodone overdose can be dangerous due to its effects on multiple neurotransmitter systems, including serotonin receptors and alpha-adrenergic receptors, potentially leading to CNS depression, cardiovascular effects, and serotonin syndrome if combined with other serotonergic medications, as discussed in 1. Key considerations in treatment include:
• Recognizing the potential for serotonin syndrome, especially if trazodone is combined with other serotonergic medications
• Being aware of the risk of QT prolongation and arrhythmias, and taking steps to monitor and manage these complications
• Providing supportive care to manage symptoms and prevent further complications
• Considering the use of medications like cyproheptadine for serotonin syndrome, as mentioned in 1

From the FDA Drug Label

Death from overdose has occurred in patients ingesting trazodone hydrochloride tablets and other CNS depressant drugs concurrently (alcohol; alcohol and chloral hydrate and diazepam; amobarbital; chlordiazepoxide; or meprobamate) The most severe reactions reported to have occurred with overdose of trazodone hydrochloride tablets alone have been priapism, respiratory arrest, seizures, and ECG changes, including QT prolongation. The reactions reported most frequently have been drowsiness and vomiting. Overdosage may cause an increase in incidence or severity of any of the reported adverse reactions There is no specific antidote for trazodone hydrochloride overdose. In managing overdosage, consider the possibility of multiple drug involvement. For current information on the management of poisoning or overdose, contact a poison control center (1-800-222-1222 or www.poison.org).

The treatment for trazodone overdose or over sedation involves:

• Managing the overdose by considering the possibility of multiple drug involvement
• Contacting a poison control center (1-800-222-1222 or www.poison.org) for current information on the management of poisoning or overdose
• No specific antidote is available for trazodone hydrochloride overdose Key considerations include:
• Monitoring for severe reactions such as priapism, respiratory arrest, seizures, and ECG changes
• Watching for frequent reactions like drowsiness and vomiting 2 2

From the Research

Treatment of Trazodone Overdose/Over Sedation

The treatment for trazodone overdose or over sedation involves supportive care and close monitoring to prevent complications.

• Supportive management includes fluid resuscitation, electrolyte repletion, and telemetry monitoring for arrhythmias 3.
• Patients with trazodone overdose should be closely monitored for QTc prolongation, which can lead to fatal arrhythmias such as torsades de pointes and variable atrioventricular blocks 3, 4.
• In cases of severe overdose, patients may develop seizures, cardiogenic shock, and respiratory arrest, requiring treatment with antiepileptics, norepinephrine, and dopamine infusion 4.
• Standard treatment for trazodone overdose includes emptying of the stomach, activated charcoal, and cathartic, as well as close observation to monitor and support the respiratory and cardiovascular systems 5.

Special Considerations

• Trazodone overdose can also lead to serotonin syndrome, characterized by confusion, agitation, rigidity, myoclonus, and hyperreflexia, especially when combined with other serotomimetic agents or monoamine oxidase inhibitors 6.
• The safety profile of trazodone in overdose is considered mild compared to other antidepressant compounds, with sedation being the most common side effect 5, 7.
• Geriatric patients and those with serious physical illnesses may require special consideration in the treatment of trazodone overdose, although further experience is needed to determine a recommended treatment procedure 5.