Serotonin syndrome
Abstract
Background: Serotonin syndrome is a potentially life-threatening syndrome that is precipitated by the use of serotonergic drugs and overactivation of both the peripheral and central postsynaptic 5HT-1A and, most notably, 5HT-2A receptors. This syndrome consists of a combination of mental status changes, neuromuscular hyperactivity, and autonomic hyperactivity. Serotonin syndrome can occur via the therapeutic use of serotonergic drugs alone, an intentional overdose of serotonergic drugs, or classically, as a result of a complex drug interaction between two serotonergic drugs that work by different mechanisms. A multitude of drug combinations can result in serotonin syndrome.
Methods: This review describes the presentation and management of serotonin syndrome and discusses the drugs and interactions that can precipitate this syndrome with the goal of making physicians more alert and aware of this potentially fatal yet preventable syndrome.
Conclusion: Many commonly used medications have proven to be the culprits of serotonin syndrome. Proper education and awareness about serotonin syndrome will improve the accuracy of diagnosis and promote the institution of the appropriate treatment that may prevent significant morbidity and mortality.
Keywords: Drug toxicity; serotonin syndrome.
Conflict of interest statement
References
-
- Boyer EW, Traub SJ, Grayzel J. UpToDate. Waltham, MA: Serotonin syndrome. UpToDate; 2010. Accessed 28 September 2011.
-
- Boyer EW, Shannon M. The serotonin syndrome. N Engl J Med. 2005 Mar 17;352(11):1112–1120. Erratum in: N Engl J Med. 2007 Jun 7;356(23):2437. N Engl J Med. 2009 Oct 22;361(17):1714. - PubMed
-
- Dunkley EJ, Isbister GK, Sibbritt D, Dawson AH, Whyte IM. The Hunter Serotonin Toxicity Criteria: simple and accurate diagnostic decision rules for serotonin toxicity. QJM. 2003 Sep;96(9):635–642. - PubMed
-
- Houlihan DJ. Serotonin syndrome resulting from coadministration of tramadol, venlafaxine, and mirtazapine. Ann Pharmacother. 2004 Mar;38(3):411–413. Epub 2004 Jan 23. - PubMed
-
- Chander WP, Singh N, Mukhiya GK. Serotonin syndrome in maintenance haemodialysis patients following sertraline treatment for depression. J Indian Med Assoc. 2011 Jan;109(1):36–37. - PubMed
Publication types
LinkOut - more resources
Full Text Sources
Other Literature Sources