Serotonin Syndrome following Duloxetine Administration in a Fibromyalgia Patient: Case Report and Literature Review

Choi, Joon Sul; Lee, Ji Hyun; Park, Suk Ki; Shim, Beom Jin; Choi, Woo Sung; Kim, Sang Hyun; Hwang, Seon Chool

doi:10.4078/jrd.2016.23.5.332

Cited by 5 publications

(5 citation statements)

References 9 publications

(13 reference statements)

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“…The novel remission treatment is a strict dietary strategy. It is low cost and drug free, so intrinsically not prone to collateral effects related to drug intake ( 54 ). The core of the treatment is the withdrawal from the diet of molecules that might indirectly trigger the symptoms reducing Trp absorption and, as consequence, its availability as substrate for 5-HT synthesis.…”

Section: Discussionmentioning

confidence: 99%

Fibromyalgia Syndrome: A Metabolic Approach Grounded in Biochemistry for the Remission of Symptoms

Lattanzio

2017

Front. Med.

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Fibromyalgia syndrome (FMS) is a chronic, complex, and heterogeneous disorder of still poorly understood etiopathophysiology associated with important musculoskeletal widespread pain, fatigue, non-restorative sleep, and mood disturbances. It is estimated to afflict 2–3% of the worldwide population, with clean prevalence among women. The objective of this paper is to propose a novel treatment for symptomatic remission of FMS, grounded in biochemistry and consisting in the withdrawal from the diet of molecules that can indirectly trigger the symptoms. The hypothesis develops from the evidence that low serotonin levels are involved in FMS. Serotonin is synthesized starting from the essential amino acid tryptophan. The presence of non-absorbed molecules in the gut, primarily fructose, reduces tryptophan absorption. Low tryptophan absorption leads to low serotonin synthesis that triggers FMS symptoms. Moreover not-absorbed sugars could also produce a microbiota deterioration activating a positive feedback loop: the increasing microbiota deterioration reduces the functionality of absorption both of fructose and tryptophan in the gut, entering a vicious circle. The therapeutic idea is to sustain serotonin synthesis allowing the proper tryptophan absorption. The core of the cure treatment is the exclusion from the diet of some carbohydrates and the marked reduction of some others. The main target is the limitation of total dietary fructose as marked as possible. It could be an effective strategy to get the remission of symptoms acting on the impaired biochemical pathways. The straying from the treatment is expected to cause the reappear of the symptoms.

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Section: Discussionmentioning

confidence: 99%

Fibromyalgia Syndrome: A Metabolic Approach Grounded in Biochemistry for the Remission of Symptoms

Lattanzio

2017

Front. Med.

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“…The marked improvements of the patient’s clinical condition open great perspectives to face up FMS burden giving the patients an effective strategy. Intrinsically, a withdrawal approach avoids the potential side-effects associated with pharmacological therapies [i.e., SSRIs and SNRIs ( 13 , 34 – 36 ), muscle relaxants, and the interactions among them]. The effectiveness-to-cost ratio of this approach is evident.…”

Section: Discussionmentioning

confidence: 99%

“…The ineffectiveness of pharmacological therapies in FMS came to patient’s knowledge ( 1 ). The patient refused the proposed muscle relaxant drug (i.e., tizanidine) on the basis of its unproven effectiveness ( 1 ), and she also refused the proposed selective serotonin–norepinephrine re-uptake inhibitor (SNRI) (i.e., duloxetine) ( 12 ) on the basis of awareness of collateral effects ( 13 ) and development of pharmacological addiction. The patient generally feared collateral effects of the drug treatments, and she was rather interested in the novel metabolic approach for the symptomatic remission in FMS ( 11 ).…”

Section: Case Presentationmentioning

confidence: 99%

Fibromyalgia Syndrome: A Case Report on Controlled Remission of Symptoms by a Dietary Strategy

Lattanzio

Imbesi

2018

Front. Med.

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A 34-year-old woman suffered from significant chronic pain, depression, non-restorative sleep, chronic fatigue, severe morning stiffness, leg cramps, irritable bowel syndrome, hypersensitivity to cold, concentration difficulties, and forgetfulness. Blood tests were negative for rheumatic disorders. The patient was diagnosed with Fibromyalgia syndrome (FMS). Due to the lack of effectiveness of pharmacological therapies in FMS, she approached a novel metabolic proposal for the symptomatic remission. Its core idea is supporting serotonin synthesis by allowing a proper absorption of tryptophan assumed with food, while avoiding, or at least minimizing the presence of interfering non-absorbed molecules, such as fructose and sorbitol. Such a strategy resulted in a rapid improvement of symptoms after only few days on diet, up to the remission of most symptoms in 2 months. Depression, widespread chronic pain, chronic fatigue, non-restorative sleep, morning stiffness, and the majority of the comorbidities remitted. Energy and vitality were recovered by the patient as prior to the onset of the disease, reverting the occupational and social disabilities. The patient episodically challenged herself breaking the dietary protocol leading to its negative test and to the evaluation of its benefit. These breaks correlated with the recurrence of the symptoms, supporting the correctness of the biochemical hypothesis underlying the diet design toward remission of symptoms, but not as a final cure. We propose this as a low risk and accessible therapeutic protocol for the symptomatic remission in FMS with virtually no costs other than those related to vitamin and mineral salt supplements in case of deficiencies. A pilot study is required to further ground this metabolic approach, and to finally evaluate its inclusion in the guidelines for clinical management of FMS.

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“…Many types of drugs and drug interactions are associated with serotonin syndrome, most of which occur in the context of a serotonergic drug overdose and the combined use of monoamine oxidase inhibitors and other related drugs [5]. Cases of serotonin syndrome caused by monotherapy at therapeutic doses are rare but occasionally reported [6][7][8][9]. Duloxetine, a selective serotonin and noradrenaline reuptake inhibitor, was not included in the list of drugs that may cause serotonin syndrome [5].…”

Section: Introductionmentioning

confidence: 99%

Serotonin Syndrome From Duloxetine Monotherapy: A Case Report

Li,

2023

Cureus

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Serotonin syndrome is a rare adverse reaction induced by serotonergic drugs. Most instances of the syndrome occur in the context of a serotonergic drug overdose and the combined use of monoamine oxidase inhibitors and other related drugs. We report a case of serotonin syndrome caused by duloxetine alone in an elderly Asian woman and review the literature. A 69-year-old woman was admitted to the hospital due to two months of irritability and reduced energy. She was diagnosed with depressive disorder in the outpatient department and took sertraline 75mg for one month, but there was no significant improvement of symptoms. After admission, sertraline was switched to duloxetine. After taking duloxetine 60mg, the patient developed confusion, inducible clonus, diaphoresis, tremor, hyperreflexia, and increased body temperature and blood pressure. Reviewing her history of drug exposure, physical examination, and associated laboratory tests, we ruled out other possible diseases and established a serotonin syndrome diagnosis. The symptoms and signs associated with serotonin syndrome disappeared within two days after treatments with hydration and diazepam and the withdrawal of duloxetine. Physicians should be watchful for serotonin syndrome, a rare, but in severe cases life-threatening, adverse drug reaction. It may occur with duloxetine monotherapy even at therapeutic doses.

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Serotonin Syndrome following Duloxetine Administration in a Fibromyalgia Patient: Case Report and Literature Review

Cited by 5 publications

References 9 publications

Fibromyalgia Syndrome: A Metabolic Approach Grounded in Biochemistry for the Remission of Symptoms

Fibromyalgia Syndrome: A Metabolic Approach Grounded in Biochemistry for the Remission of Symptoms

Fibromyalgia Syndrome: A Case Report on Controlled Remission of Symptoms by a Dietary Strategy

Serotonin Syndrome From Duloxetine Monotherapy: A Case Report

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