Serotonin Syndrome in a Sertraline-Treated Man Taking NyQuil Containing Dextromethorphan for Cold

Sethi, Roopa; Kablinger, Anita S.; Kavuru, Bush

doi:10.4088/pcc.12l01388

Cited by 3 publications

(3 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…There have been limited case reports citing interactions between dextromethorphan10 and SSRIs. Other reported interaction involved SSRIs and monoamine oxidase inhibitors, such as selegiline 3.…”

Section: Discussionmentioning

confidence: 99%

Serotonin syndrome caused by drug to drug interaction between escitalopram and dextromethorphan

Arcega²,

Ghali

et al. 2017

BMJ Case Reports

View full text Add to dashboard Cite

A 63-year-old woman with a history of long-standing depression, maintained on escitalopram, presented with altered mental status. Patient had recently been prescribed dextromethorphan-promethazine cough syrup 2 weeks prior for an upper respiratory tract infection. On admission, she was lethargic and obtunded and found to have inducible myoclonus on examination. The rest of her physical exam was unremarkable. Pertinent lab and imaging findings showed QTc prolongation on ECG, negative electroencephalogram and CT head findings, essentially normal blood tests and a negative toxicology screen. The patient was admitted to the step down unit for close observation; both escitalopram and the cough syrup were suspended and was supportively managed. Overnight the patient's mental status improved and the serial EcGs showed resolution of the prolonged QTc. Patient was discharged home without further complication.

show abstract

Section: Discussionmentioning

confidence: 99%

Serotonin syndrome caused by drug to drug interaction between escitalopram and dextromethorphan

Arcega²,

Ghali

et al. 2017

BMJ Case Reports

View full text Add to dashboard Cite

show abstract

“…Alternatively, bupropion may be the best choice in a patient with risk factors for serotonin syndrome, as dextromethorphan also binds to the serotonin reuptake transporter with high to moderate affinity 9 . Although the risk of serotonin syndrome is low, there are case studies where the combination of selective serotonin reuptake inhibitors and dextromethorphan has induced serotonin syndrome, 10,11 and the risk would be further elevated if the patient were on additional serotonergic agonist medications. Notably, the combination of dextromethorphan 45 mg and bupropion 105 mg is currently pending FDA approval for major depressive disorder, treatment resistant depression, and Alzheimer disease agitation.…”

Section: Discussionmentioning

confidence: 99%

“…9 A systematic review has shown that pooled accuracy measures in differentiating between Parkinson disease and vascular or drug-induced parkinsonism were relatively high, with sensitivity and specificity values greater than 85% and 80%, respectively. 10 Hence, he was diagnosed with drug-associated parkinsonism, and an extensive workup also indicated the likely bradykinetic dysphagia associated with long-term use of olanzapine. Even after explaining the complications that may occur with dysphagia, he declined to switch to another drug or even decrease the dose of olanzapine.…”

mentioning

confidence: 99%

Management of Pseudobulbar Affect With Fluoxetine and Dextromethorphan

Bent

Hwang

Meyer

et al. 2021

J Clin Psychopharmacol

View full text Add to dashboard Cite

Management of severe arterial hypertension associated with serotonin syndrome: a case report analysis based on systematic review techniques

Ott

Mannchen

Jamshidi

et al. 2019

Therapeutic Advances in Psychopharmacology

View full text Add to dashboard Cite

Serotonin syndrome is thought to arise from serotonin excess. In many cases, symptoms are mild and self-limiting. But serotonin syndrome can become life threatening, when neuromuscular hyperexcitability spins out of control. Uncontainable neuromuscular hyperexcitability may lead to cardiovascular complications, linked to extreme changes in blood pressure. Currently, there is little guidance on how to control blood pressure in hyperserotonergic states. We report a case with treatment-resistant arterial hypertension, followed by a clinical review (using systematic review principles and techniques) of the available evidence from case reports published between 2004 and 2016 to identify measures to control arterial hypertension associated with serotonin syndrome. We conclude that classic antihypertensives may not be effective for the treatment of severe hypertension associated with serotonin syndrome. Benzodiazepines may lower blood pressure. Patients with severe hypertension not responding to benzodiazepines may benefit from cyproheptadine, propofol or both. In severe cases, higher cyproheptadine doses than currently recommended may be necessary.

show abstract

Serotonin Syndrome in a Sertraline-Treated Man Taking NyQuil Containing Dextromethorphan for Cold

Cited by 3 publications

References 8 publications

Serotonin syndrome caused by drug to drug interaction between escitalopram and dextromethorphan

Serotonin syndrome caused by drug to drug interaction between escitalopram and dextromethorphan

Management of Pseudobulbar Affect With Fluoxetine and Dextromethorphan

Management of severe arterial hypertension associated with serotonin syndrome: a case report analysis based on systematic review techniques

Contact Info

Product

Resources

About