Abstract

BackgroundSerotonin toxicity is a known side effect of selective serotonin reuptake inhibitors and has previously also been described as a possible side effect of 5-hydroxytryptamine receptor agonist (triptan) medications. However, the literature is conflicted about the risk of developing serotonin toxicity as a result of drug interaction between selective serotonin reuptake inhibitors and triptans.Case presentationA 30-year-old Caucasian woman with a history of depression on regular fluvoxamine presented to the emergency department with right-sided facial and lower limb twitching. The patient had recently been prescribed sumatriptan for migraines and had taken her first ever dose shortly prior to the onset of symptoms. She was tachycardic, diaphoretic, and hypertonic on initial assessment with bilateral lower limb and ocular clonus. Electrocardiogram showed sinus tachycardia with QT interval under the treatment interval, and pathology and imaging findings were unremarkable. Her symptoms improved with supportive management and cyproheptadine.ConclusionsThis patient’s presentation fulfilled both Sternbach and Hunter criteria for serotonin toxicity, illustrating a potential case of serotonin toxicity as a result of drug interaction between a selective serotonin reuptake inhibitor and a triptan.

Highlights

  • Serotonin toxicity is a known side effect of selective serotonin reuptake inhibitors and has previously been described as a possible side effect of 5-hydroxytryptamine receptor agonist medications

  • Selective serotonin reuptake inhibitor (SSRI) and selective norepinephrine reuptake inhibitor (SNRI) medications are commonly prescribed for management of mood and anxiety disorders, and are frequently implicated in presentations of serotonin toxicity [2]

  • 5-hydroxytryptamine receptor agonists, known as serotonin receptor agonists or triptans, are commonly prescribed for the management of migraine. They are commonly coprescribed with SSRIs and SNRIs and have been previously implicated in cases of serotonin toxicity as a result of drug interaction, such cases are rare [3]

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Summary

Conclusions

This patient’s presentation fulfilled both Sternbach and Hunter criteria for serotonin toxicity, illustrating a potential case of serotonin toxicity as a result of drug interaction between a selective serotonin reuptake inhibitor and a triptan.

Background
Discussion and conclusions

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