Serotonin syndrome as a complication of opioid withdrawal therapy (clinical case)

Abstract

Serotonin syndrome is a dangerous, potentially fatal condition resulting from increased intrasynaptic serotonin levels, leading to activation of serotonin 5‑HT2A receptors in the central nervous system (CNS). The most common iatrogenic cause of this syndrome is the prescription of serotomimetic agents (selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic and tetracyclic antidepressants, etc.). Excess serotonin in the CNS manifests itself as neuromuscular hyperactivity, autonomic dysfunction, and changes in mental status. Symptoms occur suddenly and progress rapidly: in 60 % of cases they appear within 6 hours of administration, and after 24 hours, clinical manifestations are observed in > 85 % of patients. Due to the lack of specific laboratory criteria, Hunter criteria and Sternbach criteria have been adopted for diagnosing this syndrome. The purpose of the work: to analyze pharmacotherapy of a patient with opioid withdrawal syndrome to assess its rationality and possible complications.