Serotonin syndrome resulting from drug interactions

Chan, Betty; Graudins, Andis; Whyte, Ian M; Dawson, Andrew; Braitberg, George; Duggin, Geoffrey G.

doi:10.5694/j.1326-5377.1998.tb123399.x

Cited by 57 publications

(39 citation statements)

References 11 publications

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“…15 The combination of SSRIs with other agents such as, dextromorphan, MDMA, lithium, TCAs, and monoamine oxidase inhibitors that also increase CNS serotonin concentrations may lead to the development of the serotonin syndrome. 182 The serotonin syndrome can also occur after lone SSRI overdose, or overdose of SSRIs and non-serotonergic agents. 183 This is characterised by changed mental status (agitation, confusion, coma), autonomic instability (diaphoresis, hyperpyrexia, tachycardia, hypertension), and neuromuscular dysfunction (myoclonus, hyper-reflexia, muscle rigidity, tremor) 184 and can potentially occur with therapeutic doses of serotonergic agents.…”

Section: Selective Serotonin Reuptake Inhibitorsmentioning

confidence: 99%

Acute poisoning: understanding 90% of cases in a nutshell

Greene¹,

Dargan²,

Jones³

2005

Postgraduate Medical Journal

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The acutely poisoned patient remains a common problem facing doctors working in acute medicine in the United Kingdom and worldwide. This review examines the initial management of the acutely poisoned patient. Aspects of general management are reviewed including immediate interventions, investigations, gastrointestinal decontamination techniques, use of antidotes, methods to increase poison elimination, and psychological assessment. More common and serious poisonings caused by paracetamol, salicylates, opioids, tricyclic antidepressants, selective serotonin reuptake inhibitors, benzodiazepines, non-steroidal anti-inflammatory drugs, and cocaine are discussed in detail. Specific aspects of common paediatric poisonings are reviewed.

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Section: Selective Serotonin Reuptake Inhibitorsmentioning

confidence: 99%

Acute poisoning: understanding 90% of cases in a nutshell

Greene¹,

Dargan²,

Jones³

2005

Postgraduate Medical Journal

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“…McDaniel (2001) reported three cases of serotonin syndrome and reiterated that cyproheptadine reduced the severity of signs and symptoms but did not alter the time required for resolution. In addition, Chan et al (1998) wrote that cyproheptadine does not have any dopamine antagonist properties and thus can be safely administered in cases in which NMS cannot be differentiated from serotonin syndrome.…”

Section: Treatmentmentioning

confidence: 98%

Serotonin Syndrome

Prator¹

2006

Journal of Neuroscience Nursing

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“…Drug toxicity has been reported with the concomitant administration of cimetidine, a potent CYP450 inhibitor, which decreases moclobemide clearance by up to 50%. When co-administered with SSRIs, plasma levels of moclobemide are considerably increased and thus it is one of the most commonly implicated drugs in cases of SS [93,94].…”

Section: Moclobemidementioning

confidence: 99%

Review: Pharmacogenetic aspects of the effect of cytochrome P450 polymorphisms on serotonergic drug metabolism, response, interactions, and adverse effects

Pilgrim

Gerostamoulos

Drummer

2010

Forensic Sci Med Pathol

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The field of pharmacogenetics contains a wealth of potential for the enhancement of clinical practice by providing a more effective match between patient and drug, consequently reducing the probability of an adverse drug reaction. Although a relatively novel concept in the forensic context, pharmacogenetics has the capability to assist in the interpretation of drug related deaths, particularly in unintentional drug poisonings where the cause of death remains unclear. However, the complex pharmacology of the drugs when subjected to genetic variations in metabolism makes interpretation of the expected response and adverse events difficult. Many possess multiple metabolic pathways, narrow therapeutic indices and active metabolites or enantiomers which may be eliminated via different pathways to the parent drug. A number of these drugs, which are metabolised primarily by the CYP450 system, are also associated with serotonin syndrome, or serotonin toxicity, especially when used concomitantly with other serotonin active drugs which rely on the same metabolic pathways for drug elimination. A comprehensive understanding of polymorphic drug metabolism and its expected outcomes is therefore essential when interpreting the involvement of drugs in adverse reactions. This review examines the genetically variable CYP450-mediated metabolism of a number of serotonin-active drugs that are often implicated in cases of serotonin toxicity, to assess the impact of pharmacogenetics on drug metabolism, response, interactions and adverse effects.

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Serotonin syndrome resulting from drug interactions

Cited by 57 publications

References 11 publications

Acute poisoning: understanding 90% of cases in a nutshell

Acute poisoning: understanding 90% of cases in a nutshell

Serotonin Syndrome

Review: Pharmacogenetic aspects of the effect of cytochrome P450 polymorphisms on serotonergic drug metabolism, response, interactions, and adverse effects

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