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    Serotonin Syndrome (Drug-Induced)

    Serotonin Syndrome (Drug-Induced) is a topic covered in the 5-Minute Emergency Consult.

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    Basics

    Description

    • Constellation of signs and symptoms from excessive stimulation of central and peripheral serotonergic receptors
    • Spectrum of symptoms may range from mild and subtle findings to severe and sometimes fatal toxicity
    • Results from use of serotonergic agents, alone or in combination with other serotonergic agents (may be therapeutic, intentional overdose, recreational, drug interactions)
    • Classic triad:
      • Autonomic dysfunction: Hyperthermia, diaphoresis, tachycardia, and hypertension
      • Cognitive changes: Confusion, agitation, hallucinations, decreased responsiveness
      • Neuromuscular excitability: Hyperreflexia, myoclonus, tremors

    Epidemiology

    Incidence and Prevalence Estimates
    • SSRIs implicated most often, alone or in combination with other drugs
    • Incidence higher in females but fatalities greater in males
    • Highest incidence in ages 19–39
    • Most fatalities from drug/drug interactions or recreational abuse

    Etiology

    • Serotonin produced by metabolism of L-tryptophan
    • Exerts action on 5-hydroxytryptophan (5-HT) receptors of which there are 7 types located in central and peripheral nervous systems:
      • Influences sleep and temperature regulation, affective behavior, food intake, migraines, emesis, sexual behavior, nociception, motor tone, GI motility, and vascular tone
    • Extensive list of serotonergic agents, with psychiatric meds most common (SSRIs, SNRIs):
      • Examples: Citalopram, desvenlafaxine, duloxetine, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline, trazodone, venlafaxine
    • Other serotonergic agents include (not exhaustive):
      • Buspirone, cocaine, dextromethorphan, fentanyl, lithium, MAOIs, MDMA (ecstasy), meperidine, methadone, metoclopramide, ondansetron, selegiline, St. John's wort, TCAs, tramadol, triptans (controversial)

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    Citation

    Rosen, Peter, et al., editors. "Serotonin Syndrome (Drug-Induced)." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307686/all/Serotonin_Syndrome__Drug_Induced_.
    Serotonin Syndrome (Drug-Induced). In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307686/all/Serotonin_Syndrome__Drug_Induced_. Accessed April 25, 2019.
    Serotonin Syndrome (Drug-Induced). (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307686/all/Serotonin_Syndrome__Drug_Induced_
    Serotonin Syndrome (Drug-Induced) [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 25]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307686/all/Serotonin_Syndrome__Drug_Induced_.
    * Article titles in AMA citation format should be in sentence-case
    TY - ELEC T1 - Serotonin Syndrome (Drug-Induced) ID - 307686 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307686/all/Serotonin_Syndrome__Drug_Induced_ PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -