Serotonin Syndrome After the Use of Tramadol and Ziprasidone in a Patient With a Deep Brain Stimulator for Parkinson Disease

Abstract

Serotonin syndrome (SS) is a life-threatening adverse reaction that can result from the therapeutic use of serotonergic drugs or accidental drug interactions. Tramadol is a drug that is widely prescribed because of its low abuse potential, but physicians need to be aware of its significant potential to cause SS because it inhibits serotonin reuptake. Ziprasidone is an atypical antipsychotic that can also cause dangerous interactions to cause SS because it is not only a potent 5-HT1A agonist but also has been reported to inhibit serotonin reuptake with an affinity similar to tricyclic antidepressants, in addition to inhibiting reuptake of norepinephrine. We are describing the clinical characteristics of a gentleman with bipolar disorder and Parkinson disease who presented with SS, despite having a deep brain stimulator in the subthalamic nucleus, which decreases central serotonin levels, and a discussion of the factors that contributed to his presentation.

Drug Repositioning to Accelerate Drug Development Using Social Media Data: Computational Study on Parkinson Disease

“…Tramadol is an analgesic widely prescribed because of its low abuse potential, but researchers found serotonin syndrome, a life-threatening adverse reaction, in a PD patient who used tramadol and ziprasidone [ 54 ].…”

“…A clinical trial that conducted parallel comparison experiments on 14 patients demonstrated that ziprasidone is effective in ameliorating psychotic symptoms in PD patients [ 55 ]. However, serotonin syndrome occurred in a PD patient using ziprasidone for bipolar disorder [ 54 ]. Therefore, further studies are needed to evaluate the efficacy of ziprasidone for PD.…”

Clinically relevant interactions between newer antidepressants and second-generation antipsychotics

“…Case reports suggest that some SGAs may decrease the risk for serotonin syndrome, while other SGAs may increase the risk for serotonin syndrome. In that sense ziprasidone may be a special case, since it can inhibit serotonin reuptake and has been proposed as the single agent causing serotonin syndrome in one case [102] and as a contributing factor in two others [103,104]. Other cases suggest that withdrawal from olanzapine [105] or clozapine [106] may have contributed to serotonin syndrome.…”

Tramadol Poisoning

“…The exact rate of SS is unclear but is generally not expected to occur in more than 5% of the hospitalized patients [5,44,53,[96][97][98]. The (+) enantiomer of tramadol inhibits re-absorption of serotonin [99].…”