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Serotonin syndrome (SS) is a reaction caused by medicines that increase the levels of serotonin in the nervous system. It is potentially fatal.
Signs and symptomsEdit
Its symptoms include: diarrhoea, tachycardia, shivering, sweating, hypertension, mydriasis (dilated pupils), mental status changes (including mania, confusion, agitation, hyperactivity, restlessness and psychosis), seizures, coma, tremor, incoordination, hyperthermia, etc. Most fatalities are due to rhabdomyolysis, disseminated intravascular coagulation, respiratory distress syndrome or severe hyperthermia.
It is most commonly precipitated by more than one medicine that acts on serotonin being given at once. Known causes include those listed in table 1.
|Class of drug||Examples|
|Analgesics (painkillers)||Buprenorphine, cyclobenzaprine, dextropropoxyphene, fentanyl, hydrocodone, morphine, oxycodone, pentazocine, pethidine (or meperidine), tapentadol and tramadol.|
|Antidepressants||MAOIs, NaSSAs, NDRIs, SARIs, SNRIs and SSRIs.|
|Antiemetics||5-HT3 antagonists (blockers) such as granisetron and ondansetron; D2 antagonists such as droperidol and metoclopramide.|
|Anti-migraine medicines||Triptans (e.g., sumatriptan) and ergotamines (e.g., dihydroergotamine).|
|Antipsychotics||Olanzapine, reserpine and risperidone.|
|Illicit drugs||MDMA, 5-MeO-DiPT (“foxy methoxy”), lysergide (LSD) and other psychedelics.|
|OTC and complimentary medicines||Brompheniramine, chlorphenamine (or chlorpheniramine), dextromethorphan, Panax ginseng, St. John’s wort, S-adenosylmethionine (SAMe), Syrian rue and yohimbe.|
|Others||5-hydroxytryptophan, buspirone, carbamazepine (an anti-seizure medicine that is also used as a mood stabilizer), fluconazole, levodopa, linezolid, lithium, methylene blue, selegiline, tryptophan and valproic acid (an anti-seizure medicine that is also used as a mood stabilizer). Certain foods may contribute to SS, including cheese and red wine.|
|Stimulants||Amfetamines (including dexamfetamine and metamfetamine), cocaine and methylphenidate|
|Weight loss medicines||Amfepramone (diethylpropion), phentermine and sibutramine (no longer marketed).|
Treatment usually consists of supportive measures (that is, managing the symptoms like hyperthermia) and treatment with serotonin antagonists (blockers). Amongst serotonin antagonists usually cyproheptadine is preferred, but sometimes chlorpromazine or propanolol may be used.
The prognosis for SS is generally favourable, provided the diagnosis is made early and the treatment is begun without delay.
- NCBI Bookshelf provides free book resources on this topic.
- PubMed provides review articles from the past five years (limit to free review articles or to systematic reviews)
- The TRIP database provides clinical publications about evidence-based medicine.
- Wikipedia's entry (classified as a Good article)
- ↑ 1.0 1.1 Hall, M; Buckley, N (June 2003). "Serotonin syndrome". Australian Prescriber (Strawberry Hills, Australia: National Prescribing Service) 26 (3): 62–63.
- ↑ Boyer, EW; Shannon, M (2005). "The serotonin syndrome" (PDF). New England Journal of Medicine 352 (11): 1112–20. PMID 15784664. doi:10.1056/NEJMra041867.
- ↑ "Prescribing Practice Review 32: Managing depression in primary care" (PDF). NPS.org.au. National Prescribing Service Limited. 2005. Retrieved 13 August 2014.
- ↑ Iqbal, MM; Basil, MJ; Kaplan, J; Iqbal, MT (November 2012). "Overview of serotonin syndrome.". Annals of Clinical Psychiatry 24 (4): 310–8. PMID 23145389.
- ↑ Volpi-Abadie, J; Kaye, AM; Kaye, AD (Winter 2013). "Serotonin syndrome.". The Ochsner Journal 13 (4): 533–40. PMC 3865832. PMID 24358002.