Abstract
Serotonin syndrome is a potentially life-threatening adverse drug reaction that may occur following therapeutic drug use, inadvertent interactions between drugs, overdose of particular drugs, or the recreational use of certain drugs. Serotonin syndrome is not an idiosyncratic drug reaction; it is a predictable consequence of excess serotonergic activity at central nervous system (CNS) and peripheral serotonin receptors [1]. for this reason, some experts strongly prefer the terms serotonin toxicity or serotonin toxidrome because these more accurately reflect the fact that it is a form of poisoning. It may also be called serotonin sickness, serotonin storm, serotonin poisoning, hyperserotonemia, or serotonergic syndrome [2, 3]. The excess serotonin activity produces a spectrum of specific symptoms including cognitive, autonomic, and somatic effects. The symptoms may range from barely perceptible to fatal. [1]Numerous drugs and drug combinations have been reported to produce serotonin syndrome. Diagnosis of serotonin syndrome includes observing the symptoms produced and a thorough investigation of the patient’s history. The syndrome has a characteristic picture but can be mistaken for other illnesses in some patients, particularly those with neuroleptic malignant syndrome. No laboratory tests can currently confirm the diagnosis [3].
Highlights
Serotonin syndrome is a potentially life-threatening adverse drug reaction that may occur following therapeutic drug use, inadvertent interactions between drugs, overdose of particular drugs, or the recreational use of certain drugs
Serotonin syndrome is not an idiosyncratic drug reaction; it is a predictable consequence of excess serotonergic activity at central nervous system (CNS) and peripheral serotonin receptors [1]. for this reason, some experts strongly prefer the terms serotonin toxicity or serotonin toxidrome because these more accurately reflect the fact that it is a form of poisoning
A large number of medications either alone or in combination can produce serotonin syndrome, such as : Monoamine oxidase inhibitors (MAOIs), TCAs, SSRIs, SNRIs, tramadol, valproate, buspirone, lithium, linezolid, dextromethorphan, pethidine, fentanyl, sibutramine [1], nefazodone, trazodone[5], amphetamine, chlorpheniramine, methylphenidate, methamphetamine,LSD,L-Dopa, risperidone [6,7,8,9], olanzapine[10], Many cases of serotonin toxicity occur in patients who have ingested drug combinations that synergistically increase synaptic serotonin [4]
Summary
Serotonin syndrome is a potentially life-threatening adverse drug reaction that may occur following therapeutic drug use, inadvertent interactions between drugs, overdose of particular drugs, or the recreational use of certain drugs. The excess serotonin activity produces a spectrum of specific symptoms including cognitive, autonomic, and somatic effects. Diagnosis of serotonin syndrome includes observing the symptoms produced and a thorough investigation of the patient’s history.
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