From the Guidelines
Trazodone puede causar bradicardia como efecto secundario, por lo que es fundamental monitorear la frecuencia cardíaca en pacientes que toman este medicamento, especialmente en aquellos con antecedentes de problemas cardíacos o que toman otros medicamentos que pueden afectar la frecuencia cardíaca. La bradicardia se refiere a una frecuencia cardíaca anormalmente lenta, y según la guía de 2019 de la American College of Cardiology/American Heart Association [ 1 ], las manifestaciones clínicas de la bradicardia pueden variar desde síntomas insidiosos hasta episodios de síncope franca.
Los pacientes que toman trazodone y experimentan síntomas como mareos, fatiga, debilidad o, en casos graves, desmayos, deben comunicarse de inmediato con su proveedor de atención médica. El riesgo de bradicardia es mayor en pacientes ancianos, aquellos con condiciones cardíacas preexistentes o cuando trazodone se combina con otros medicamentos que ralentizan la frecuencia cardíaca.
Es importante destacar que la guía [ 1 ] define la "bradicardia sintomática" como una bradiarritmia documentada que es directamente responsable del desarrollo de manifestaciones clínicas como síncope, presíncope, mareos transitorios o lightheadedness, síntomas de insuficiencia cardíaca o estados confusionales resultantes de hipoperfusión cerebral atribuible a una frecuencia cardíaca lenta. Por lo tanto, es crucial que los pacientes bajo tratamiento con trazodone sean monitoreados de cerca para detectar cualquier signo de bradicardia y ajustar el tratamiento según sea necesario para minimizar el riesgo de complicaciones cardíacas.
From the FDA Drug Label
Occasional sinus bradycardia has occurred in long-term studies. Cardiac disorders: cardio spasm, congestive heart failure, conduction block, orthostatic hypotension and syncope, palpitations, bradycardia, atrial fibrillation, myocardial infarction, cardiac arrest, arrhythmia, ventricular ectopic activity, including ventricular tachycardia and QT prolongation. Trazodone Hydrochloride Tablets should also be avoided in patients with a history of cardiac arrhythmias, as well as other circumstances that may increase the risk of the occurrence of torsade de pointes and/or sudden death, including symptomatic bradycardia, hypokalemia or hypomagnesemia, and the presence of congenital prolongation of the QT interval
Trazodone puede causar bradicardia. Se han reportado casos de bradicardia sinusoidal ocasional en estudios a largo plazo 2. Además, se han identificado trastornos cardíacos como bradicardia en la experiencia post-comercialización 2. Es importante tener cuidado al administrar Trazodone a pacientes con enfermedad cardíaca, especialmente aquellos con antecedentes de arritmias cardíacas o circunstancias que puedan aumentar el riesgo de torsade de pointes y/o muerte súbita, incluyendo bradicardia sintomática 2.
From the Research
Trazodone and Bradycardia
- Trazodone is a triazolopyridine derivative used as an antidepressant, which has also been found to have some anxiolytic and hypnotic activity 3.
- There have been reports of trazodone-induced bradycardia, with one case study documenting symptomatic bradycardia following a single low dose of trazodone 50mg 4.
- Studies have shown that trazodone tends to lower heart rate, with lower doses (100-300 mg) being better tolerated and more effective in major depressives with significant cardiovascular disease 5.
- The adverse effects of trazodone generally mirror its serotonergic activity, and clinicians and patients should be cognizant of the risk for potential, but rare, cardiovascular adverse effects, including bradycardia 6.
- Research has also investigated the cellular mechanisms for trazodone-induced cardiotoxicity, including its effects on cardiac action potentials and ion channels, which may contribute to the development of bradycardia 7.
Cardiovascular Effects of Trazodone
- Trazodone has been found to have little effect on cardiac conduction, and does not worsen supraventricular arrhythmias 5.
- However, trazodone can produce postural hypotension, and has been associated with increased ventricular premature beats and repetitive forms in patients with preexisting ventricular irritability 5.
- The drug has also been found to inhibit major ion channels, including hERG, which can contribute to its cardiotoxic effects 7.
Clinical Implications
- Clinicians should be aware of the potential for trazodone to induce bradycardia, particularly in patients with preexisting cardiovascular disease 4, 5.
- Lower doses of trazodone may be better tolerated and more effective in these patients, and the drug should be used with caution in patients with ventricular irritability 5.
- Further research is needed to fully understand the cardiovascular effects of trazodone and to optimize its safety profile 6, 7.