Clinician's Pocket Drug Reference 2008

242 TablesTABLE 12SSRIs/SNRI/Triptan and Serotonin SyndromeA life-threatening condition, when selective serotonin reuptake inhibitors(SSRIs) and 5-hydroxytryptamine receptor agonists (triptans) are used together.However, many other drugs have been implicated (see below). Signsand symptoms of serotonin syndrome include the following:Restlessness, coma, N/V/D, hallucinations, loss of coordination, overactivereflexes, ↑ HR/temperature, rapid changes in BP, increased body temperatureClassAntidepressantsCNS stimulants5-HT 1 agonistsIllicit drugsOpioidsOthersDrugsMAOIs, TCAs, SSRIs, SNRIs, mirtazapine, venlafaxineAmphetamines, phentermine, methylphenidate,sibutramineTriptansCocaine, methylenedioxymethamphetamine (ecstasy),lysergic acid diethylamide (LSD)Tramadol, pethidine, oxycodone, morphine, meperidineBuspirone, chlorpheniramine, dextromethorphan,linezolid, lithium, selegiline, tryptophan, St John’sWortManagement includes removal of the precipitating drugs, and supportive care. To control agitation serotoninantagonists (cyproheptadine or methysergide) can be used. When mild symptoms are mild, discontinuation ofthe medication or medications, and the control of agitation with benzodiazepines may be needed. Critically illpatients may require sedation and mechanical ventilation as well as control of hyperthermia. (Boyer EW, ShannonM (2005). “The Serotonin Syndrome”. N Engl J Med 352 (11): 1112–20)