Serotonin syndrome: Difference between revisions
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==Cause/etiology== | ==Cause/etiology== | ||
The serotonin syndrome may be caused by many drugs including [[antidepressant]]s. Coadministration of drugs that inhibit the [[cytochrome P-450]] CYP2D6 and CYP3A4 metabolism of [[antidepressant]]s may increase the risk.<ref name="pmid15784664"/> | The serotonin syndrome may be caused by many drugs including [[antidepressant]]s. Coadministration of drugs that inhibit the [[cytochrome P-450]] CYP2D6 and CYP3A4 metabolism of [[antidepressant]]s may increase the risk.<ref name="pmid15784664"/> | ||
==Diagnosis== | |||
The most important finding is [[clonus]].<ref name="pmid15784664"/> | |||
===Differential diagnosis=== | |||
The distinction between [[serotonin syndrome]], [[neuroleptic malignant syndrome]], [[malignant hyperthermia]], and toxicity from [[cholinergic agent]]s has been reviewed ([http://content.nejm.org/cgi/content/full/352/11/1112/T2 see chart]).<ref name="pmid15784664"/> The most difficult distinction is between serotonin syndrome and neuroleptic malignant syndrome as patients may be on drugs that could cause either disorder. Serotonin syndrome shows hyperkinesia, hyperreflexia, and hyperactive bowel sounds, while neuroleptic malignant syndrome shows bradykinesia, bradyreflexia and normal or diminished bowel sounds. A helpful guide is that "dopamine antagonists produce bradykinesia, whereas serotonin agonists produce hyperkinesia".<ref name="pmid15784664"/> Lastly, neuroleptic malignant syndrome may develop over several days while serotonin syndrome develops faster. | |||
==Notable cases== | ==Notable cases== | ||
Revision as of 10:19, 2 April 2008
Serotonin syndrome is an "adverse drug interaction characterized by altered mental status, autonomic dysfunction, and neuromuscular abnormalities. It is most frequently caused by use of both serotonin reuptake inhibitors and monoamine oxidase inhibitors, leading to excess serotonin availability in the CNS at the serotonin 1A receptor."[1][2]
Cause/etiology
The serotonin syndrome may be caused by many drugs including antidepressants. Coadministration of drugs that inhibit the cytochrome P-450 CYP2D6 and CYP3A4 metabolism of antidepressants may increase the risk.[2]
Diagnosis
The most important finding is clonus.[2]
Differential diagnosis
The distinction between serotonin syndrome, neuroleptic malignant syndrome, malignant hyperthermia, and toxicity from cholinergic agents has been reviewed (see chart).[2] The most difficult distinction is between serotonin syndrome and neuroleptic malignant syndrome as patients may be on drugs that could cause either disorder. Serotonin syndrome shows hyperkinesia, hyperreflexia, and hyperactive bowel sounds, while neuroleptic malignant syndrome shows bradykinesia, bradyreflexia and normal or diminished bowel sounds. A helpful guide is that "dopamine antagonists produce bradykinesia, whereas serotonin agonists produce hyperkinesia".[2] Lastly, neuroleptic malignant syndrome may develop over several days while serotonin syndrome develops faster.
Notable cases
The death of Libby Zion was due to serotonin syndrome caused by a combination of meperidine and phenelzine.[2] This case had a profound impact on graduate medical education and residency work hour limitations.[3]
References
- ↑ Anonymous (2024), Serotonin syndrome (English). Medical Subject Headings. U.S. National Library of Medicine.
- ↑ 2.0 2.1 2.2 2.3 2.4 2.5 Boyer EW, Shannon M (2005). "The serotonin syndrome". N. Engl. J. Med. 352 (11): 1112-20. DOI:10.1056/NEJMra041867. PMID 15784664. Research Blogging.
- ↑ Brensilver JM, Smith L, Lyttle CS (1998). "Impact of the Libby Zion case on graduate medical education in internal medicine". Mt. Sinai J. Med. 65 (4): 296-300. PMID 9757752. [e]