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Neda Frayha, MD and Aisha Lofters, MD
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David E. -

excellent

Neda F., MD -

Thanks, David! -- Neda

Chris -

I might have just missed it, but other than the anticholinergic effects we should be considering the potential QT prolonging effects of trazodone. On the hospitalist side of things we're lucky to have a recent ECG on almost everyone and easy access to an ECG if not, but I imagine that even when prescribing for outpatients it would be reasonable to consider getting an ECG if you're going up to higher doses of trazodone or if the patient is concurrently on any other potentially QT prolonging agents even if you're considering just a low dose of trazodone?

Neda F., MD -

Hi Chris. That's a great point. From what we researched, the risk of QTc prolongation with the use of trazodone alone is quite low, <1% according to Up to Date and "not associated with clinically significant increases in QTc intervals at therapeutic doses" according to this US Pharmacist resource: https://www.uspharmacist.com/article/qtc-prolongation-with-antidepressants-and-antipsychotics. Certainly if they're on more than one med that might prolong QTc, or if they have other CV risk factors, it would be wise to check an ECG beforehand.

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Primary Care RAP Written Summary May 2020 981 KB - PDF

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