Serotonin Syndrome in the Setting of Lamotrigine, Aripiprazole, and Cocaine Use.

Anupam Kotwal,Sarah L Cutrona

doi:10.1155/2015/769531

Anupam Kotwal, Sarah L Cutrona

Open Access

https://doi.org/10.1155/2015/769531

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Abstract

Serotonin syndrome is a potentially life-threatening condition associated with increased serotonergic activity in the central nervous system. It is classically associated with the simultaneous administration of two serotonergic agents, but it can occur after initiation of a single serotonergic drug or increasing the dose of a serotonergic drug in individuals who are particularly sensitive to serotonin. We describe a case of serotonin syndrome that occurred after ingestion of higher than prescribed doses of lamotrigine and aripiprazole, in addition to cocaine abuse. The diagnosis was established based on Hunter toxicity criteria and severity was classified as mild. The features of this syndrome resolved shortly after discontinuation of the offending agents. Serotonin syndrome is characterized by mental status changes, autonomic hyperactivity, and neuromuscular abnormalities along a spectrum ranging from mild to severe. Serotonin syndrome in our patient was most likely caused by the pharmacokinetic and pharmacodynamic interactions between lamotrigine, aripiprazole, and cocaine leading to increased CNS serotonergic activity.

Highlights

Serotonin syndrome is a potentially life-threatening condition associated with increased serotonergic activity in the central nervous system (CNS)
A 24-year-old Caucasian female with a psychiatric history of bipolar disorder, posttraumatic stress disorder (PTSD), and cocaine abuse was admitted for nausea, dizziness, and jitteriness that started after intentional ingestion of 4 gm of lamotrigine and 80 mg of aripiprazole, in addition to cocaine abuse
Serotonin syndrome in our patient was most likely caused by the pharmacokinetic and pharmacodynamic interactions between lamotrigine, aripiprazole, and cocaine leading to increased CNS serotonergic activity

Summary

Introduction

Serotonin syndrome is a potentially life-threatening condition associated with increased serotonergic activity in the central nervous system (CNS). It is classically associated with the simultaneous administration of two serotonergic agents, but it can occur after initiation of a single serotonergic drug or increasing the dose of a serotonergic drug in individuals who are sensitive to serotonin [1,2,3,4]. Lamotrigine, aripiprazole, and cocaine have traditionally not been associated with this syndrome and none of them have strong serotonergic activity by themselves. An extensive literature search on PubMed did not yield any case description of serotonin syndrome induced by lamotrigine, aripiprazole, and cocaine alone or in combination. We hypothesize that pharmacokinetic and pharmacodynamic interactions between these agents were responsible for inducing serotonin syndrome in our patient

Case Presentation

Discussion

Conclusions

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