Does Trazodone cause prolonged QTc? (+3 factors)

In this article, we will discuss whether Trazodone causes prolonged QT interval. We will share the factors that can contribute to prolonged QT interval while using Trazodone. Moreover, this article will also mention the safest antidepressants for cardiovascular patients.

Does Trazodone cause prolonged QTc?

Trazodone can cause prolonged QTc. However, it is not a common side effect of Trazodone. Although cardiac side effects are not common in standard doses of Trazodone, it could still affect some people.

The QT interval is the measure of the heart’s electrical cycle. Prolongation of the QT interval can potentially lead to a serious, life-threatening heart rhythm disorder known as Torsade de Pointes (1).

Trazodone is normally not considered an ideal antidepressant to be used in people who have active cardiac diseases, this is because it is more cardiotoxic than other antidepressants.

If we talk about a healthy individual with this medication, he/she may not experience cardiac side effects. Prolonged QT interval could also be an early side effect in someone who’s new to Trazodone or antidepressants in general.

In such cases, heart issues go away on their own, as your body adjusts to the medication. On the other hand, if this issue persists reach out to your healthcare provider immediately.

How does Trazodone cause prolonged QTc?

The exact mechanism behind the prolongation of QT interval due to Trazodone is not fully known. However, there are some possibilities regarding this phenomenon.

Trazodone is an antidepressant which when administered at higher doses can exert a more pronounced adrenergic effect, potentially leading to elevated heart rate and blood pressure (2).

Trazodone increases the level of certain neurotransmitters, including serotonin, in the brain. These neurotransmitters play a role in the cardiovascular system and can influence the QT interval. They can interact with ion channels in the heart, affecting the electrical conduction system (3).

However, the specific interactions with the ion channels that may contribute to QT interval prolongation are not fully elucidated. It is important to note that the risk of Trazodone affecting heart rhythm is generally considered to be low at lower doses.

However, individuals taking Trazodone, especially at higher doses, must be closely monitored for QT interval prolongation and heart pounding.

What factors contribute to prolonged QT interval while using Trazodone?

Several factors can contribute to the prolonged QT interval associated with Trazodone. These include (4):

  • The incidence of prolonged QT interval is dose-dependent. Higher doses of Trazodone are more likely to cause QT interval prolongation.
  • Some individuals are more susceptible to QT interval prolongation, regardless of medication use.
  • Certain medications such as other antidepressants, and antipsychotics can interact with Trazodone and increase the risk of QT interval prolongation.
  • Individuals with a history of heart rhythm disorders, congenital long QT syndrome and hyperthyroidism are at higher risk of experiencing QT interval prolongation.
  • Elderly females are more likely to experience QT interval prolongation and other cardiovascular events.
  • Alcohol can interact with Trazodone and increase the risk of QT interval prolongation.
  • Low levels of potassium, magnesium and calcium can significantly lead to changes in the heart rhythm.

What to do if Trazodone causes prolonged QT interval?

If you suspect that Trazodone is causing QT interval prolongation or is affecting your heart functioning, it is important to reach out to your healthcare provider.

Your healthcare provider will likely conduct a thorough medical evaluation including ECG to assess your heart’s electrical activity and determine the suitable interventions.

If your healthcare provider suspects that Trazodone is the main culprit, they may consider dose reduction. If dose adjustment does not work, your healthcare provider may gradually discontinue your medication to mitigate the risk of QT interval prolongation.

Do not discontinue the antidepressant on your own as it can cause horrible withdrawal symptoms further worsening your condition (5).

Your doctor may recommend regular exercise, a balanced diet, and stress management to protect your heart.

Regular monitoring is essential to track your heart rhythm and QT interval. This can ensure your heart is functioning properly.

What are alternatives if Trazodone causes QTc prolongation?

Some antidepressants are considered safer for individuals with cardiovascular conditions. However, individual responses to antidepressants vary widely.

SSRIs are often considered among the safer options for cardiovascular patients. These include

  • Sertraline (Zoloft)
  • Escitalopram (Lexapro)
  • Fluoxetine (Prozac)
  • Citalopram (Celexa)

Based on my research, it is evident that Trazodone can cause QT interval prolongation. Although it is generally considered safe at lower doses, close monitoring is required.

I recommend you talk to your doctor about your symptoms or concerns regarding prolonged QT interval. Always follow your healthcare provider’s recommendations and attend regular check-ups to monitor your health while on antidepressant therapy.




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