scholarly journals Serotonin Syndrome with Escitolapram and Concomitant Use of Cocaine: A Case Report

2012 ◽  
Vol 5 ◽  
pp. CCRep.S9540 ◽  
Author(s):  
Hamood Ur-Rehman Malik ◽  
Krishan Kumar
Keyword(s):  
Serotonin Syndrome ◽  
Mental Illnesses ◽  
Drug Abusers ◽  
Serotonergic Activity ◽  
Psychotropic Agents ◽  
Threatening Condition ◽  
Autonomic Instability ◽  
Life Threatening ◽  
The Central Nervous System ◽  
Serotonergic Drugs

Introduction Serotonin syndrome is a potentially life-threatening condition caused by excessive serotonergic activity in the central nervous system. It is characterized by mental status changes (eg, confusion, agitation, lethargy, coma), autonomic instability (eg, hyperthermia, tachycardia, diaphoresis, nausea, vomiting, diarrhea, dilated pupils), and neuromuscular hyperactivity (eg, myoclonus, hyperreflexia, rigidity, trismus). Serotonin syndrome classically occurs in patients receiving two or more serotonergic drugs, but it can occur with monotherapy. We report a case of a 20-year-old man who developed serotonin syndrome resulting from overdose of Escitolapram with concomitant use of cocaine. It is a very important area in medicine as serotonin syndrome should be suspected especially in drug abusers who are being treated with psychotropic agents for mental illnesses.

scholarly journals Serotonin Syndrome in the Setting of Lamotrigine, Aripiprazole, and Cocaine Use

2015 ◽  
Vol 2015 ◽  
pp. 1-3 ◽  
Author(s):  
Anupam Kotwal ◽  
Sarah L. Cutrona
Keyword(s):  
Cocaine Abuse ◽  
Serotonin Syndrome ◽  
Pharmacodynamic Interactions ◽  
Serotonergic Activity ◽  
Threatening Condition ◽  
Neuromuscular Abnormalities ◽  
Life Threatening ◽  
The Central Nervous System ◽  
Autonomic Hyperactivity ◽  
Toxicity Criteria

Serotonin syndrome is a potentially life-threatening condition associated with increased serotonergic activity in the central nervous system. It is classically associated with the simultaneous administration of two serotonergic agents, but it can occur after initiation of a single serotonergic drug or increasing the dose of a serotonergic drug in individuals who are particularly sensitive to serotonin. We describe a case of serotonin syndrome that occurred after ingestion of higher than prescribed doses of lamotrigine and aripiprazole, in addition to cocaine abuse. The diagnosis was established based on Hunter toxicity criteria and severity was classified as mild. The features of this syndrome resolved shortly after discontinuation of the offending agents. Serotonin syndrome is characterized by mental status changes, autonomic hyperactivity, and neuromuscular abnormalities along a spectrum ranging from mild to severe. Serotonin syndrome in our patient was most likely caused by the pharmacokinetic and pharmacodynamic interactions between lamotrigine, aripiprazole, and cocaine leading to increased CNS serotonergic activity.

scholarly journals Tramadol, Pharmacology, Side Effects, and Serotonin Syndrome: A Review

2015 ◽  
Vol 18;4 (4;18) ◽  
pp. 395-400
Author(s):  
Alan David Kaye
Keyword(s):  
Side Effects ◽  
Drug Interactions ◽  
Serotonin Syndrome ◽  
Potential Side Effect ◽  
Serotonergic Activity ◽  
Potential Abuse ◽  
Life Threatening ◽  
The Central Nervous System ◽  
Physician Reviews ◽  
Serotonergic Drugs

Background: Serotonin syndrome is a mild to potentially life-threatening syndrome associated with excessive serotonergic activity within the central nervous system. Serotonin syndrome is associated with medication use, drug interactions, and overdose. While serotonin syndrome is often associated with the use of selective serotonin inhibitors (SSRI), an increasing number of reports are being presented involving the use of tramadol. Methods: This review article contains an overview of serotonin syndrome while specifically looking at tramadol’s pharmacology and risk factors for serotonin syndrome. With tramadol’s increasing popularity, the goal of this article is to make physicians more alert and aware of this potential side effect associated with tramadol. Conclusions: In conclusion, with the increasing incidence of serotonin syndrome, prescribing physicians should be aware of and educate their patients on the potential side effects of tramadol. It is important that the prescribing physician reviews patient medications for concurrent serotonergic drugs and monitors for potential abuse. Key words: Tramadol, serotonin syndrome, drug interactions, analgesics

Postoperative Serotonin Syndrome Following Methylene Blue Administration for Vasoplegia After Cardiac Surgery: A Case Report and Review of the Literature

2020 ◽  
pp. 108925322096025
Author(s):  
Mafdy N. Basta
Keyword(s):  
Methylene Blue ◽  
Case Report ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Serotonin Syndrome ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Medical Emergency ◽  
Serotonergic Activity ◽  
Threatening Condition ◽  
Life Threatening

Serotonin syndrome is a potentially life-threatening condition associated with increased serotonergic activity in the central nervous system. The increasing incidence of this condition is thought to parallel the increasing use of serotonergic agents in medical practice. The selective serotonin reuptake inhibitors are perhaps the most commonly implicated group of medications associated with serotonin syndrome. This case report describes the occurrence of postoperative serotonin syndrome in a patient on long-term sertraline who underwent coronary artery bypass graft and was treated with methylene blue for perioperative vasoplegia. It delineates the various clinical features commonly encountered and illustrates the recommended management modalities, including prevention, for this potentially lethal medical emergency. With prompt diagnosis and expeditious treatment, the patient has had full recovery.

scholarly journals Clinical Relevance of Pharmacogenetics in Serotonin Syndrome

2020 ◽  
Vol 2020 ◽  
pp. 1-7 ◽  
Author(s):  
Dehuti Pandya ◽  
My Tran ◽  
Monica Verduzco-Gutierrez
Keyword(s):  
Serotonin Syndrome ◽  
Low Dose ◽  
Genetic Profile ◽  
Threatening Condition ◽  
Life Threatening ◽  
Additive Risk ◽  
Serotonergic Drugs ◽  
Higher Doses ◽  
Dose Change ◽  
Stimulation Of

Serotonin syndrome is a predictable life-threatening condition that is caused by serotonergic stimulation of the central and peripheral nervous systems. A patient’s genetic profile can amplify exposure risk as many serotonergic drugs are metabolized by CYP450 enzymes, and these enzymes may be altered in functionality. We report a case of an elderly man who presented with serotonin syndrome after a dose change in valproic acid 5 weeks prior. His medication list consisted of low-dose serotonergic agents, which is unusual as most cases of serotonin syndrome involve higher doses. A review of his pharmacogenetic profile is presented to retrospectively evaluate the additive risk for serotonin syndrome and implications on resuming serotonergic agents.

Neuroleptic Malignant Syndrome and Serotonin Syndrome

2019 ◽  
Author(s):  
Richard Sanders ◽  
Richard Krysiak
Keyword(s):  
Neuroleptic Malignant Syndrome ◽  
Dopamine Agonists ◽  
Serotonin Syndrome ◽  
Clinical Symptoms ◽  
Altered Mental Status ◽  
Muscle Relaxants ◽  
Autonomic Instability ◽  
Life Threatening ◽  
Dopamine Circuits ◽  
Pharmacologic Treatments

Serotonin syndrome (SS) and neuroleptic malignant syndrome (NMS) are iatrogenic life-threatening conditions with similar clinical symptoms. Altered mental status, rigidity, and autonomic instability are common in both serotonin overload and toxic dopamine antagonism. It is paramount that providers understand the key differences between these two pathologies, as pharmacologic treatments can exacerbate the condition if SS is mistaken for NMS or vice versa. Hyperreflexia, clonus, diarrhea, and vomiting suggest the excessive activity of serotonin circuits in SS, whereas prominent rigidity and hyporeflexia suggest the underactivity of dopamine circuits in NMS. Supportive care and discontinuing the offending agent(s) are keys to treating both syndromes, but serotonin antagonists (eg, cyproheptadine) could be helpful in SS, whereas NMS may sometimes benefit from muscle relaxants (eg, dantrolene) and dopamine agonists (eg, bromocriptine). Following recovery, decisions about further use of an inciting agent (or similar agents) require reconsideration of risks, benefits, and alternatives, based on newly realized hazards. It is usually important to wait at least 2 weeks before rechallenge with any drugs resembling the inciting agents. This review contains 1 figure, 5 tables, and 29 references. Key Words: bromocriptine, cyproheptadine, dantrolene, Hunter criteria, neuroleptic malignant syndrome, parkinsonism, serotonin syndrome

Serotonin Syndrome

2019 ◽  
pp. 467-471
Author(s):  
Kevin T. Gobeske ◽  
Eelco F. M. Wijdicks
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Autonomic Nervous System ◽  
Serotonin Syndrome ◽  
Neuromuscular System ◽  
Autonomic Nervous ◽  
Life Threatening ◽  
The Central Nervous System ◽  
Serotonin Toxicity

Serotonin syndrome affects the central nervous system, the autonomic nervous system, and the neuromuscular system and can have acute and potentially life-threatening manifestations. By definition, serotonin syndrome is associated with changes in serotonin exposure and thus might be described more accurately as serotonergic excess or serotonin toxicity. The central nervous system effects of serotonin involve regulation of attention, arousal, mood, learning, appetite, and temperature.

Serotonin Syndrome

2016 ◽  
Author(s):  
Ravi Mirpuri ◽  
Danielle Perret Karimi
Keyword(s):  
Cardiac Arrhythmias ◽  
Serotonin Syndrome ◽  
Complex Disease ◽  
Altered Mental Status ◽  
Detailed Understanding ◽  
Neuromuscular Abnormalities ◽  
Life Threatening ◽  
The Central Nervous System ◽  
Autonomic Hyperactivity

Serotonin syndrome (SS) is a complication that occurs due to drug interactions that result in an increase in serotonin in the central nervous system. This syndrome is classically described as a triad of altered mental status, autonomic hyperactivity, and neuromuscular abnormalities that can be life threatening. As such, prompt detection is crucial so that treatment can be delivered to prevent long-term complications from hyperthermia, malignant hypertension, and/or cardiac arrhythmias. Determining the diagnosis can be difficult as several other conditions have similarities to SS; these include malignant hyperthermia, neuroleptic malignant syndrome, and anticholinergic toxicity. If appropriately managed, SS typically resolves within 24 hours once all serotoninergic medications are discontinued. If inappropriately prescribed, serotoninergic drugs such as antibiotics, analgesics, supplements, or antidepressants may all contribute toward inducing this preventable syndrome, if given in excess. This comprehensive review of SS provides the clinician with a detailed understanding of the pathogenesis, diagnosis, and treatment of this complex disease state

scholarly journals Serotonin Syndrome: Pathophysiology, Clinical Features, Management, and Potential Future Directions

2019 ◽  
Vol 12 ◽  
pp. 117864691987392 ◽  
Author(s):  
William J Scotton ◽  
Lisa J Hill ◽  
Adrian C Williams ◽  
Nicholas M Barnes
Keyword(s):  
Serotonin Syndrome ◽  
Tryptophan Hydroxylase ◽  
Monoamine Oxidase Inhibitor ◽  
Receptor Activation ◽  
Clinical Findings ◽  
Oxidase Inhibitor ◽  
Health Concern ◽  
Drug Induced ◽  
Life Threatening ◽  
Serotonergic Drugs

Serotonin syndrome (SS) (also referred to as serotonin toxicity) is a potentially life-threatening drug-induced toxidrome associated with increased serotonergic activity in both the peripheral (PNS) and central nervous systems (CNS). It is characterised by a dose-relevant spectrum of clinical findings related to the level of free serotonin (5-hydroxytryptamine [5-HT]), or 5-HT receptor activation (predominantly the 5-HT1A and 5-HT2A subtypes), which include neuromuscular abnormalities, autonomic hyperactivity, and mental state changes. Severe SS is only usually precipitated by the simultaneous initiation of 2 or more serotonergic drugs, but the syndrome can also occur after the initiation of a single serotonergic drug in a susceptible individual, the addition of a second or third agent to long-standing doses of a maintenance serotonergic drug, or after an overdose. The combination of a monoamine oxidase inhibitor (MAOI), in particular MAO-A inhibitors that preferentially inhibit the metabolism of 5-HT, with serotonergic drugs is especially dangerous, and may lead to the most severe form of the syndrome, and occasionally death. This review describes our current understanding of the pathophysiology, clinical presentation and management of SS, and summarises some of the drugs and interactions that may precipitate the condition. We also discuss the newer novel psychoactive substances (NPSs), a growing public health concern due to their increased availability and use, and their potential risk to evoke the syndrome. Finally, we discuss whether the inhibition of tryptophan hydroxylase (TPH), in particular the neuronal isoform (TPH2), may provide an opportunity to pharmacologically target central 5-HT synthesis, and so develop new treatments for severe, life-threatening SS.

Linezolid-Associated Serotonin Syndrome

2015 ◽  
Vol 105 (3) ◽  
pp. 244-248 ◽  
Author(s):  
Robert G. Frykberg ◽  
Scott Gordon ◽  
Edward Tierney ◽  
Jaminelli Banks
Keyword(s):  
Serotonin Syndrome ◽  
Monoamine Oxidase Inhibitor ◽  
Case Series ◽  
Oxidase Inhibitor ◽  
Serotonin Release ◽  
Diabetic Foot Infections ◽  
Complicated Skin ◽  
Antibiotic Drug ◽  
Threatening Condition ◽  
Life Threatening

Linezolid, a mild monoamine oxidase inhibitor, is a commonly used antibiotic drug for the treatment of complicated skin and skin structure infections, including diabetic foot infections. Use of linezolid has been associated with serotonin syndrome, a potentially life-threatening condition typically caused by the combination of two or more medications with serotonergic properties, due to increased serotonin release. The goals of this article are to highlight the risk factors associated with the development of serotonin syndrome related to the use of linezolid and to aid in its prevention and early diagnosis. In this case series we report on two hospitalized patients who, while being treated with linezolid for pedal infections, developed serotonin syndrome. Both individuals were also undergoing treatment with at least one serotonergic agent for depression and had received this medication within 2 weeks of starting the antibiotic drug therapy. In these individuals, we noted agitation, confusion, tremors, and tachycardia within a few days of initiation of linezolid therapy. Owing to the risk of serotonin toxicity, care should be taken when prescribing linezolid in conjunction with any other serotonergic agent. Although serotonin syndrome is an infrequent complication, it can be potentially life threatening. Therefore, risks and benefits of therapy should be weighed before use.

scholarly journals Intramedullary abscess associated with acute bacterial meningitis: a case report and review of the literature

2020 ◽  
Vol 10 (3) ◽  
pp. 120-123
Author(s):  
Marouane Hammoud ◽  
Fayçal Lakhdar ◽  
Mohammed Benzagmout ◽  
Khalid Chakour, ◽  
Mohammed El Faiz Chaou
Keyword(s):  
Spinal Cord ◽  
Bacterial Meningitis ◽  
Antibiotic Therapy ◽  
Contralateral Side ◽  
Acute Bacterial Meningitis ◽  
Intramedullary Spinal Cord ◽  
Intramedullary Abscess ◽  
Threatening Condition ◽  
Life Threatening ◽  
The Central Nervous System

Intramedullary spinal cord abscess (ISCA) is a rare infection of the central nervous system. Untreated, it may result in significant morbidity and mortality. We describe the case of a 34-year-old man, who initially was admitted for bacterial meningitis. 3 days after initiation of antibiotic therapy, a gradually and progressive weakness appeared on the left side of his body with numbness on the contralateral side. MRI of the spine demonstrated an ISCA at level of C4. A myelotomy and surgical drainage was performed. Postoperatively, the patient had improved significantly his neurological deficit. ISCA is still a life-threatening condition, we point out that the diagnosis should be highly suspected, if a cystic spinal cord lesion is surrounded by significant medullar edema associated with fast onset of symptoms, especially in a context of sepsis or acuate meningitis. Prompt surgical evacuation followed by adequate antibiotic therapy, are the mainstays of treatment.

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