Drug-induced serotonin syndrome: a review
- 1 September 2008
- journal article
- review article
- Published by Informa Healthcare in Expert Opinion on Drug Safety
- Vol. 7 (5), 587-596
- https://doi.org/10.1517/14740338.7.5.587
Abstract
Serotonin syndrome, or serotonin toxicity (ST), is a clinical condition that occurs as a result of an iatrogenic drug-induced increase in intrasynaptic serotonin levels primarily resulting in activation of serotonin2A receptors in the central nervous system. The severity of symptoms spans a spectrum of toxicity that correlates with the intrasynaptic serotonin concentration. Although numerous drugs have been implicated in ST, life-threatening cases generally occur only when monoamine oxidase inhibitors are combined with either selective or nonselective serotonin re-uptake inhibitors. The triad of clinical features consists of neuromuscular hyperactivity, autonomic hyperactivity and altered mental status, which may present abruptly and progress rapidly. The awareness of ST is crucial not only in avoiding the unintentional lethal combination of therapeutic drugs but also in recognizing the clinical picture when it occurs so that treatment can be promptly initiated. In this review, the pathophysiology, clinical features, implicated drugs, diagnosis and treatment of ST are discussed.Keywords
This publication has 67 references indexed in Scilit:
- A Review of Serotonin Toxicity Data: Implications for the Mechanisms of Antidepressant Drug ActionBiological Psychiatry, 2006
- The Serotonin SyndromeThe New England Journal of Medicine, 2005
- Serotonin syndromePublished by Oxford University Press (OUP) ,2004
- The Hunter Serotonin Toxicity Criteria: simple and accurate diagnostic decision rules for serotonin toxicityQJM: An International Journal of Medicine, 2003
- The serotonin syndromeAmerican Journal of Psychiatry, 1991
- Interactions between relatively selective monoamine oxidase inhibitors and an inhibitor of 5-hydroxytryptamine re-uptake, clomipramineJournal of Psychiatric Research, 1985
- Interactions of non-selective monoamine oxidase inhibitors, tranylcypromine and nialamide, with inhibitors of 5-hydroxytryptamine, dopamine or noradrenaline re-uptakeJournal of Psychiatric Research, 1984
- Interactions of a non-selective monoamine oxidase inhibitor, phenelzine, with inhibitors of 5-hydroxytryptamine, dopamine or noradrenaline re-uptakeJournal of Psychiatric Research, 1984
- Clinical and experimental aspects of interactions between amine oxidase inhibitors and amine re-uptake inhibitorsPsychological Medicine, 1983
- Neurologic effects of tryptophan in patients receiving a monoamine oxidase inhibitorNeurology, 1960