Toxicité sérotoninergique provoquée par une interaction entre le fentanyl et la paroxétine

Transplantation provides life-saving therapy to critically ill patients with end-stage organ failure. We found that the specialized knowledge of mental health clinicians and physicians, committed to the evaluation and management of transplant recipients, is essential for the optimal care of these patients who require a life-long regimen of immunosuppressive medication and dependency on the transplant team. Critical issues requiring psychiatric input are frequently encountered in the following areas (1) patient selection and informed consent; (2) recognition and pretransplant treatment of psychiatric disorders; (3) substance or alcohol abuse; (4) compliance with medical regimens; (5) posttransplant psychosis; and (6) immunosuppressive/psychiatric drug-drug interactions. This review focuses on the priorities in psychological and psychiatric care of these unique patients.

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“…A recent report is the first to link fentanyl and an SSRI (paroxetine) with postoperative serotonin toxicity (49).…”

Section: Drug-drug Interactionsmentioning

confidence: 99%

Psychiatric Care of Patients Undergoing Organ Transplantation

Surman

Cosimi²,

DiMartini³

2009

Transplantation

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“…Neurochemically, the drug causes excessive serotonin (5-hydroxytryptamine; 5HT) release widespread within the brain (Baumann et al, 2008; Ma et al, 2013). As a result, all 5HT receptor subtypes are simultaneously activated to a great extent, presumably upsetting a neural balance between inhibitory and excitatory networks, and disturbing many aspects of the body and mind such as mood, autonomic function and somatic neuromuscular activities (Mason et al, 2000; Rang et al, 2008). …”

mentioning

confidence: 99%

Mechanisms and environmental factors that underlying the intensification of 3,4-methylenedioxymethamphetamine (MDMA, Ecstasy)-induced serotonin syndrome in rats

et al. 2014

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Rationale Illicit use of MDMA (3,4-methylenedioxymethamphetamine; Ecstasy) may cause a mild or severe form of the serotonin syndrome. The syndrome intensity is not just influenced by drug doses but also by environmental factors. Objectives Warm environmental temperatures and physical activity are features of raves. The purpose of this study was to assess how these two factors can potentially intensify the syndrome. Methods Rats were administered MDMA at doses of 0.3, 1 or 3 mg/kg, and examined in the absence or presence of warm temperature and physical activity. The syndrome intensity was estimated by visual scoring for behavioral syndrome and also instrumentally measuring changes in symptoms of the syndrome. Results Our results showed that MDMA at 3 mg/kg, but not 0.3 or 1 mg/kg, caused a mild serotonin syndrome in rats. Each environmental factor alone moderately intensified the syndrome. When the two factors were combined, the intensification became more severe than each factor alone highlighting a synergistic effect. This intensification was blocked by the 5-HT2A receptor antagonist M100907, competitive NMDA receptor antagonist CGS19755, autonomic ganglionic blocker hexamethonium, and the benzodiazepine-GABAA receptor agonist midazolam, but not by the 5-HT1A receptor antagonist WAY100635 or nicotinic receptor antagonist methyllycaconitine. Conclusions Our data suggest that, in the absence of environmental factors, the MDMA-induced syndrome is mainly mediated through the serotonergic transmission (5HT-dependent mechanism), and therefore, is relatively mild. Warm temperature and physical activity facilitate serotonergic and other neural systems such as glutamatergic and autonomic transmissions, resulting in intensification of the syndrome (non-5HT mechanisms).

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“…24 Also, patients receiving serotoninergic antidepressants risk developing serotonin syndrome, 25 with the risk increasing when co-administered with tramadol. 26 Clinical features may not present until after surgery and include tremor, agitation, myoclonus, hyperthermia, and hypertension.…”

Section: • Fentanylmentioning

confidence: 99%