pharmacology/trazodone

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683d1311c1b3f4bd827da9cf

Psychiatry

pharmacology

trazodone

A 45-year-old male presents to an outpatient psychiatric consultation service for management of severe depressive symptoms with passive suicidal ideation. He reports a long-standing history of hypertension managed with various agents, rheumatoid arthritis, and occasional gout flares. Of particular concern is a prior episode of priapism, approximately three years ago, which necessitated emergency department intervention with intracavernous phenylephrine after lasting over six hours. He recalls it was attributed to a new antihypertensive medication at the time, although he cannot remember the specific drug. Physical examination is unremarkable aside from mild tenderness and swelling in the metacarpophalangeal joints, consistent with his rheumatoid arthritis. Considering his medical history, which of the following antidepressant medications, if initiated, would pose the most significant risk of recurrence of his previously experienced severe adverse event, and therefore should be avoided in his treatment plan?

Lab ParameterValueReference Range
Hemoglobin145 g/L130-170 g/L
White Blood Cell Count7.2 x 10^9/L4.0-11.0 x 10^9/L
Platelets280 x 10^9/L150-400 x 10^9/L
Sodium140 mmol/L135-145 mmol/L
Potassium4.1 mmol/L3.5-5.0 mmol/L
Creatinine85 umol/L60-110 umol/L
Glucose (fasting)5.2 mmol/L3.9-6.1 mmol/L
Alanine Aminotransferase (ALT)30 U/L10-40 U/L
Aspartate Aminotransferase (AST)25 U/L10-40 U/L
Thyroid Stimulating Hormone (TSH)2.1 mU/L0.4-4.0 mU/L

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