Can Trazodone (triazolopyridine antidepressant) cause tachycardia?

Trazodone and Risk of Tachycardia

Yes, trazodone can cause tachycardia and other cardiac arrhythmias, especially in patients with pre-existing cardiac disease or when taken in overdose. The FDA drug label specifically lists tachycardia/palpitations as potential adverse reactions of trazodone 1.

Cardiac Effects of Trazodone

• Trazodone can cause various cardiac arrhythmias including tachycardia, palpitations, and more serious arrhythmias such as QT prolongation and torsade de pointes 1
• Post-marketing reports have identified cardiac arrhythmias including atrial fibrillation, bradycardia, conduction block, and ventricular tachycardia associated with trazodone use 1
• Torsade de pointes has been reported at doses of 100 mg or less with the immediate-release form of trazodone 1
• Clinical studies indicate that trazodone may be arrhythmogenic particularly in patients with pre-existing cardiac disease 1

Risk Factors for Trazodone-Induced Arrhythmias

• Pre-existing cardiac disease significantly increases the risk of trazodone-induced arrhythmias 1
• History of cardiac arrhythmias is a contraindication for trazodone use 1
• Other risk factors include:
  • Symptomatic bradycardia 1
  • Electrolyte abnormalities (hypokalemia or hypomagnesemia) 1
  • Congenital prolongation of QT interval 1
  • Concomitant use of other QT-prolonging medications 1

Mechanism of Cardiac Effects

• Trazodone prolongs the QT/QTc interval, which can predispose patients to arrhythmias 1
• In overdose situations, trazodone can cause significant QTc prolongation, with reports of intervals exceeding 500 ms 2
• While trazodone has fewer anticholinergic effects than tricyclic antidepressants, it still carries cardiac risks including arrhythmias 3

Clinical Considerations

• Trazodone should be avoided in patients with a history of cardiac arrhythmias 1
• It is not recommended during the initial recovery phase of myocardial infarction 1
• Patients with cardiac disease should be closely monitored when taking trazodone 1
• Concomitant use with other drugs that prolong QT interval (including Class 1A and Class 3 antiarrhythmics, certain antipsychotics, and certain antibiotics) should be avoided 1
• Lower doses (100-300 mg) are better tolerated and more effective in patients with significant cardiovascular disease 4

Severity and Frequency

• In a large-scale analysis of trazodone exposures reported to poison centers, tachycardia occurred in approximately 7% of cases 5
• QTc prolongation was reported in 12.2% of trazodone exposure cases in 2019 5
• Most trazodone exposures are of low severity, but serious cardiac events can occur, especially at higher doses 5
• A dose-response relationship exists between trazodone ingestion and severity of effects 5

Monitoring and Management

• Patients with risk factors for arrhythmias should have cardiac monitoring when starting trazodone 1
• If tachycardia or other arrhythmias develop, dose reduction or discontinuation may be necessary 1
• In overdose situations, close monitoring with serial ECGs is recommended 2
• Supportive care including fluid resuscitation and electrolyte repletion may be needed in cases of trazodone-induced arrhythmias 2

While trazodone is generally considered to have a better cardiac safety profile than tricyclic antidepressants, healthcare providers should remain vigilant about its potential to cause tachycardia and other cardiac arrhythmias, particularly in high-risk patients 3, 4.