Serotonin Syndrome Induced Tako-Tsubo Syndrome

Lancaster, Ian; Steinhoff, Jeffrey; Mosco-Guzman, Jose; Patel, Deep

doi:10.1155/2022/7551440

Cited by 4 publications

(3 citation statements)

References 18 publications

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“…The severity of the outcomes might increase, especially when serotonergic drugs combined with SSRIs or SNRIs. (Scotton et al, 2019;Lancaster et al, 2022). Consequently, when SSRIs or SNRIs are administered with serotonin reuptake inhibitors, or these drugs which could in uence the activity of cytochrome P450 enzymes clinically, SC should be considered a signi cant concern.…”

Section: Discussionmentioning

confidence: 99%

Risk of stress cardiomyopathy associated with selective serotonin reuptake inhibitors and serotonin and norepinephrine reuptake inhibitors: A real-world pharmacovigilance analysis

Tan,

Chen,

Yan

et al. 2024

Preprint

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Objective Selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) are the two commonly prescribed antidepressants, but these drugs have been reported clinically to cause stress cardiomyopathy (SC). This study aimed to evaluate the possible association between SSRI or SNRI usage and the occurrence of cardiomyopathy by mining the publicly available U.S. Food and Drug Administration Adverse Event Reporting System (FAERS) database. Methods The disproportionate analysis and likelihood ratio test were employed to identify risk signals associated with the use of SSRIs or SNRIs and the incidence of stress cardiomyopathy. The raw data was sourced from the FAERS database from 2012 to 2022. Descriptive statistics were further applied to present the demographic characteristics, time to onset, concomitant medications and prognostic outcomes. Statistical analysis and data visualization were conducted using the R v4.0.2. Results In total, 132 individual case safety reports (ICSRs) of SC associated with SSRIs or SNRIs were identified. Venlafaxine and fluoxetine were identified as the most commonly suspected antidepressant medications, accounting for 48% and 27% of the ICSRs, respectively. Approximately 80% of SC cases were reported in females, with individuals aged 45–65 identified as a high-risk population. The reporting regions were mainly in Europe and North America, with differences in antidepressant utilization preferences between geographic regions. Both venlafaxine (RSIC 2.54, 95%CI 2.06 to 3.04) and fluoxetine (RSIC 3.20, 95%CI 2.31 to 4.47) exhibited a significant disproportionality of SC, with likelihood ratio estimates of 3.55 (p = 0.02) for venlafaxine and 4.82 (p = 0.008) for fluoxetine. Propofol, lidocaine, oxycodone, gabapentin and zonisamide were the frequently co-administered with SSRIs or SNRIs. The median time to cardiomyopathy onset was 20 days. The most frequently reported outcomes were hospitalization or prolonged hospitalization in 48.33% of patients, and other serious events occurred in 12% of patients. Conclusion This analysis based on the FAERS database provided new insight into the main characteristics of adverse cardiomyopathic events associated with SSRIs and SNRIs in real-world. The risk of cardiomyopathy varied between SSRIs and SNRIs, and there was a significant disproportionate risk signal associated with stress cardiomyopathy, particularly in middle-aged women for venlafaxine and fluoxetine. Caution should be exercised when SSRIs or SNRIs are used with other serotonergic medications.

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Section: Discussionmentioning

confidence: 99%

Risk of stress cardiomyopathy associated with selective serotonin reuptake inhibitors and serotonin and norepinephrine reuptake inhibitors: A real-world pharmacovigilance analysis

Tan,

Chen,

Yan

et al. 2024

Preprint

View full text Add to dashboard Cite

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“…Alternatively, excessive serotonin levels may directly overstimulate serotonin receptors in the heart, contributing to SC development 40 . Thus, the severity of the outcomes may especially increase when serotonergic drugs are combined with SSRIs or SNRIs 41 , 42 . Therefore, SC should be considered a significant concern when SSRIs or SNRIs are administered with serotonin reuptake inhibitors or drugs that clinically influence the activity of cytochrome P450 enzymes.…”

Section: Discussionmentioning

confidence: 99%

Risk of stress cardiomyopathy associated with selective serotonin reuptake inhibitors and serotonin and norepinephrine reuptake inhibitors: a real-world pharmacovigilance analysis

Tan,

Chen,

Yan

et al. 2024

Sci Rep

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Selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) are reported to cause stress cardiomyopathy (SC). This study evaluated the association between SSRI/SNRI use and the occurrence of cardiomyopathy in the publicly available U.S. Food and Drug Administration Adverse Event Reporting System (FAERS) database. Disproportionate analysis and likelihood ratio tests were used to identify risk associated with SSRIs or SNRIs and the incidence of SC, using data from between from 2012 to 2022 acquired from the FAERS database. The study identified 132 individual case safety reports (ICSRs) of SC associated with SSRIs or SNRIs. Venlafaxine (48%) and fluoxetine (27%) were the most common antidepressants of the ICSRs. Approximately 80% of SC cases were reported in females, with individuals aged 45–65 years identified as a high-risk population. Both venlafaxine (ratio-scale information component [RSIC] 2.54, 95% CI 2.06–3.04) and fluoxetine (RSIC 3.20, 95% CI 2.31–4.47) were associated with SC, with likelihood ratio estimates of 3.55 (p = 0.02) for venlafaxine and 4.82 (p = 0.008) for fluoxetine. The median time to cardiomyopathy onset was 20 days, with hospitalization reported in 48.33% of patients. Venlafaxine and fluoxetine were associated with SC risk, particularly in middle-aged women. Caution should be exercised when using SSRIs or SNRIs combined with other serotonergic medications.

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“…However, cases are now increasingly being reported from non-toxicology centers, such as perioperative settings, neurology clinics, cardiac settings, and pediatric clinics. Several new drugs have demonstrated serotonergic properties[ 8 - 10 ]. Historically, SS has been recognized as an acute clinical condition.…”

Section: Introductionmentioning

confidence: 99%

Serotonin syndrome controversies: A need for consensus

Prakash,

Shah,

Prakash

2024

World J Crit Care Med

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Serotonin syndrome (SS) is a drug-induced clinical syndrome resulting from increased serotonergic activity in the central nervous system. Although more than seven decades have passed since the first description of SS, it is still an enigma in terms of terminology, clinical features, etiology, pathophysiology, diagnostic criteria, and therapeutic measures. The majority of SS cases have previously been reported by toxicology or psychiatry centers, particularly in people with mental illness. However, serotonergic medications are used for a variety of conditions other than mental illness. Serotonergic properties have been discovered in several new drugs, including over-the-counter medications. These days, cases are reported in non-toxicology centers, such as perioperative settings, neurology clinics, cardiology settings, gynecology settings, and pediatric clinics. Overdoses or poisonings of serotonergic agents constituted the majority of the cases observed in toxicology or psychiatry centers. Overdose or poisoning of serotonergic drugs is uncommon in other clinical settings. Patients may develop SS at therapeutic dosages. Moreover, these patients may continue to use serotonergic medications even if they develop mild to moderate SS due to several reasons. Thus, the clinical presentation (onset, severity, and clinical features) in such instances may not exactly match what toxicologists or psychiatrists observe in their respective settings. They produce considerable diversity in many aspects of SS. However, other experts discount these new developments in SS. Since SS is a potentially lethal illness, consensus is required on several concerns related to SS.

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Serotonin Syndrome Induced Tako-Tsubo Syndrome

Cited by 4 publications

References 18 publications

Risk of stress cardiomyopathy associated with selective serotonin reuptake inhibitors and serotonin and norepinephrine reuptake inhibitors: A real-world pharmacovigilance analysis

Risk of stress cardiomyopathy associated with selective serotonin reuptake inhibitors and serotonin and norepinephrine reuptake inhibitors: A real-world pharmacovigilance analysis

Risk of stress cardiomyopathy associated with selective serotonin reuptake inhibitors and serotonin and norepinephrine reuptake inhibitors: a real-world pharmacovigilance analysis

Serotonin syndrome controversies: A need for consensus

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