Serotonin Syndrome (Drug-Induced)
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Basics
Description
- Constellation of signs and symptoms from excessive serotonin and 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 wort, TCAs, tramadol, triptans (controversial)
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Basics
Description
- Constellation of signs and symptoms from excessive serotonin and 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 wort, TCAs, tramadol, triptans (controversial)
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