Concomitant Use of Triptan, and SSRI or SNRI After the US Food and Drug Administration Alert on Serotonin Syndrome

Sclar, David A.; Robison, Linda M.; Castillo, Leigh V.; Schmidt, Jennifer M.; Bowen, Kurt A.; Oganov, Ambartsum M.; Skaer, Tracy L.; Kogut, Stephen

doi:10.1111/j.1526-4610.2011.02067.x

Cited by 21 publications

(24 citation statements)

References 19 publications

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“…In contrast with our results, there was no subsequent decline in antidepressant prescribing after 2004 (Wichman et al 2008), suggesting that the regulatory warnings had modest impact on antidepressant use in the study population. These results could be considered broadly consistent with prior research showing that, in some cases, regulatory actions addressing potentially serious medication safety concerns had little impact on drug prescribing (Karpel et al 2009; Ricci et al 2009; Sclar et al 2012). However, the Wichman et al (2008) study only included women enrolled at a single medical center.…”

Section: Discussionsupporting

confidence: 90%

The effect of regulatory advisories on maternal antidepressant prescribing, 1995–2007: an interrupted time series study of 228,876 pregnancies

Bobo

Epstein

Hayes

et al. 2013

Arch Womens Ment Health

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Purpose To assess whether antidepressant prescribing during pregnancy decreased following release of U.S. and Canadian public health advisory warnings about the risk of perinatal complications with antidepressants. Methods We analyzed data from 228,876 singleton pregnancies among women (aged 15–44 years) continuously enrolled in Tennessee Medicaid with full pharmacy benefits (1995–2007). Antidepressant prescribing was determined through outpatient pharmacy dispensing files. Information on sociodemographic and clinical factors was obtained from enrollment files and linked birth certificates. An interrupted time-series design with segmented regression analysis was used to quantify the impact of the advisory warnings (2002–2005). Results Antidepressant prescribing rates increased steadily from 1995–2001, followed by sharper increases from 2002–late 2004. Overall antidepressant prescribing prevalence was 34.51 prescriptions (95% CI 33.37–35.65) per 1,000 women in January 2002, and increased at a rate of 0.46 (95% CI 0.41–0.52) prescriptions per 1,000 women per month until the end of the pre-warning period (May 2004). During the post-warning period (October 2004 – June 2005), antidepressant prescribing decreased by 1.48 (95% CI 1.62-1.35) prescriptions per 1,000 women per month. These trends were observed for both SSRI and non-SSRI antidepressants, although SSRI prescribing decreased at a greater rate. Conclusion Antidepressant prescribing to pregnant women in Tennessee Medicaid increased from 1995–late 2004. U.S. and Canadian public health advisories about antidepressant-associated perinatal complications were associated with steady decreases in antidepressant prescribing from late 2004 until the end of the study period, suggesting that the advisory warnings were impactful on antidepressant prescribing in pregnancy.

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Section: Discussionsupporting

confidence: 90%

The effect of regulatory advisories on maternal antidepressant prescribing, 1995–2007: an interrupted time series study of 228,876 pregnancies

Bobo

Epstein

Hayes

et al. 2013

Arch Womens Ment Health

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“…Since this warning, several reports have questioned the validity of the FDA’s warning based on: 1) triptans mechanism of action (Gillman, 2010) (i.e., triptans target 5-HT 1 Rs while 5-HT 2A Rs are implicated in 5-HT syndrome), 2) the inclusion of only 29 subjects in the FDA report (Evans, 2007), 3) and the lack of appropriate diagnostic criteria for subjects included in the report (Evans, 2007). Despite the FDA warning, the combined use of triptans with SSRIs or SNRIs is currently widespread (Sclar et al, 2012) without any indication of serious side effects (Rolan, 2012). Collectively, there are no contraindications for the monotherapeutic use of triptans or selective 5-HT 1B R agonists, however, patients also taking SSRIs or SNRIs should be carefully monitored until thorough toxicity studies have been conducted.…”

Section: Dysregulation Of 5-ht1brsmentioning

confidence: 99%

Dopamine D3 and 5-HT1B receptor dysregulation as a result of psychostimulant intake and forced abstinence: Implications for medications development

2014

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Addiction to psychostimulants, including cocaine and amphetamine, is associated with dysregulation of dopamine and serotonin (5-HT) neurotransmitter systems. Neuroadaptations in these systems vary depending on the stage of the drug taking-abstinence-relapse cycle. Consequently, the effects of potential treatments that target these systems may vary depending on whether they are given during abstinence or relapse. In this review, we discuss evidence that dopamine D3 receptors (D3Rs) and 5-HT1B receptors (5-HT1BRs) are dysregulated in response to both chronic psychostimulant use and subsequent abstinence. We then review findings from preclinical self-administration models which support targeting D3Rs and 5-HT1BRs as potential medications for psychostimulant dependence. Potential side effects of the treatments are discussed and attention is given to studies reporting positive treatment outcomes that depend on: 1) whether testing occurs during abstinence versus relapse, 2) whether escalation of drug self-administration has occurred, 3) whether the treatments are given repeatedly, and 4) whether social factors influence treatment outcomes. We conclude that D3/D2 agonists may decrease psychostimulant intake; however, side effects of D3/D2R full agonists may limit their therapeutic potential, whereas D3/D2R partial agonists likely have fewer undesirable side effects. D3-selective antagonists may not reduce psychostimulant intake during relapse, but nonetheless, may decrease motivation for seeking psychostimulants with relatively few side-effects. 5-HT1BR agonists provide a striking example of treatment outcomes that are dependent on the stage of the addiction cycle. Specifically, these agonists initially increase cocaine’s reinforcing effects during maintenance of self-administration, but after a period of abstinence they reduce psychostimulant seeking and the resumption of self-administration. In conclusion, we suggest that factors contributing to dysregulation of monoamine systems, including drug history, abstinence, and social context, should be considered when evaluating potential treatments to better model treatment effects in humans.

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“…Common side effects seen with escitolapram use are nausea, constipation, diarrhea, dizziness and impotence. An adverse effect of escitolapram, as with other SSRIs, is the Serotonin syndrome 1. The symptoms are variable and can easily be missed 1.…”

Section: Case Reportmentioning

confidence: 99%

Serotonin Syndrome with Escitolapram and Concomitant Use of Cocaine: A Case Report

Malik

Kumar

2012

Clin Med Insights Case Rep

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IntroductionSerotonin syndrome is a potentially life-threatening condition caused by excessive serotonergic activity in the central nervous system. It is characterized by mental status changes (eg, confusion, agitation, lethargy, coma), autonomic instability (eg, hyperthermia, tachycardia, diaphoresis, nausea, vomiting, diarrhea, dilated pupils), and neuromuscular hyperactivity (eg, myoclonus, hyperreflexia, rigidity, trismus). Serotonin syndrome classically occurs in patients receiving two or more serotonergic drugs, but it can occur with monotherapy. We report a case of a 20-year-old man who developed serotonin syndrome resulting from overdose of Escitolapram with concomitant use of cocaine. It is a very important area in medicine as serotonin syndrome should be suspected especially in drug abusers who are being treated with psychotropic agents for mental illnesses.

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Concomitant Use of Triptan, and SSRI or SNRI After the US Food and Drug Administration Alert on Serotonin Syndrome

Cited by 21 publications

References 19 publications

The effect of regulatory advisories on maternal antidepressant prescribing, 1995–2007: an interrupted time series study of 228,876 pregnancies

The effect of regulatory advisories on maternal antidepressant prescribing, 1995–2007: an interrupted time series study of 228,876 pregnancies

Dopamine D3 and 5-HT1B receptor dysregulation as a result of psychostimulant intake and forced abstinence: Implications for medications development

Serotonin Syndrome with Escitolapram and Concomitant Use of Cocaine: A Case Report

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