An intravenous line should be started and cardiac monitoring initiated on all patients. In pure trazodone ingestions, significant neurologic and cardiac toxicity is not expected and supportive care is usually the only treatment required. Specific antidotal therapy is not available. Gastrointestinal decontamination can be applied selectively in cases where the dose ingested can be accurately calculated. Ingestion of 1500 mg or less of trazodone in an adult carries a low risk of toxicity, as long as trazodone is ingested as a single agent and the patient does not have any underlying cardiac or neurologic risk factors. These patients should receive 1 g/kg of activated charcoal, and gastric lavage is probably unnecessary. Ingestions of more than 2000 mg of trazodone poses the greatest risk for associated toxicity and complications. Also, patients having coingested other drugs and/or ethanol have a higher incidence of coma, seizures, and respiratory arrest. Gastric decontamination in these patients is best achieved by early gastric lavage followed by administration of activated charcoal. Hypotension should be initially treated with isotonic intravenous fluid administration. If the use of a vasopressor becomes necessary, direct-acting vasopressors (e.g., norepinephrine) are recommended. Drugs with b-adrenergic receptor activity (e.g., dopamine) can theoretically potentiate the hypotension in the presence of trazodone-induced a-adrenergic receptor antagonism. Patients who have remained asymptomatic for at least 6 h can be safely discharged from the emergency department. This assumes that any necessary psychiatric evaluation has been completed or arranged. All intentional trazodone ingestions should be properly evaluated for the presence of other drugs (e.g., acetaminophen). Patients with neurologic and/or cardiac symptoms persisting longer than 6 h after ingestion will require hospital admission to a monitored bed. In addition, patients with coingestants associated with delayed toxicity will require prolonged observation or formal hospital admission.
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