First time, low dose citalopram use-related serotonin syndrome

Türedi, Süleyman; Eraydin, Ismet; Gunduz, Abdülkadir; Hos, Ulku

doi:10.1016/j.neuro.2007.05.004

Cited by 10 publications

(6 citation statements)

References 9 publications

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“…To date, only 5 cases of serotonin syndrome have been reported in patients using SSRI monotherapy at recommended therapeutic doses. [7][8][9][10][11] Serotonin syndrome is largely underdiagnosed due to its variable onset, nonspecific symptoms, evolving diagnostic criteria, and lack of awareness among prescribers. 14,15 Consequently, an estimated 85% of physicians fail to recognize serotonin syndrome.…”

Section: Discussionmentioning

confidence: 99%

“…5,6 To date, only 5 cases have described the occurrence of serotonin syndrome with therapeutic doses of an SSRI when prescribed as monotherapy. [7][8][9][10][11] Of the 5 case reports identified, 2 involved young males 12 years of age, 2 involved males between 40 and 60 years of age, and the other involved an 80-year-old female (Table 1). We describe a case of serotonin syndrome in a 21-year-old female taking therapeutic doses of paroxetine.…”

Section: Introductionmentioning

confidence: 99%

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A Case Report of Serotonin Syndrome in a Patient on Selective Serotonin Reuptake Inhibitor (SSRI) Monotherapy

Blake

Rimola-Dejesus

Nguyen

et al. 2019

Journal of Pharmacy Practice

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Introduction: Paroxetine is a selective serotonin reuptake inhibitor (SSRI) with several indications, one of which is for depression. We present a case of probable paroxetine-induced serotonin syndrome. Case Summary: A 21-year-old female with a history of generalized anxiety disorder and major depression presented with increased depressive symptoms over several months while taking fluoxetine 20 mg daily. Fluoxetine was discontinued without taper and replaced with paroxetine 10 mg daily, along with hydroxyzine 50 mg twice daily as needed for anxiety. Within a week of starting the paroxetine, the patient reported increased anxiety, insomnia, and constant shaking. The paroxetine continued to be uptitrated over a 3-week period to a dose 30 mg due to unremitting depressive symptoms. One month later, the patient presented with tachycardia, generalized body aches, extreme fatigue, weakness, uncontrollable twitching, tremor, and hyperreflexia. A widespread burning sensation accompanied by random hot flashes without diaphoresis was also noted. Serotonin syndrome was diagnosed using the Hunters criteria. Paroxetine was discontinued, and the patient’s physical symptoms resolved within a week. Discussion: To date, only 5 cases of serotonin syndrome have been reported in patients receiving SSRI monotherapy at recommended therapeutic doses.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A Case Report of Serotonin Syndrome in a Patient on Selective Serotonin Reuptake Inhibitor (SSRI) Monotherapy

Blake

Rimola-Dejesus

Nguyen

et al. 2019

Journal of Pharmacy Practice

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“…Azotemia was present in both cases; however, in Case 2, the patient had chronic stable renal function with the development of myoclonus only after initiation of gabapentin. Case reports implicate metformin, citalopram, albuterol, amlodipine, oxycodone, and hydromorphone as potential etiologies for myoclonus [26] , [27] , [28] , [29] , [30] , [31] , [32] . In both cases, the patients had been stable on these and other admission medications prior to the AKI in Case 1 and the addition of gabapentin in Case 2.…”

Section: Discussionmentioning

confidence: 99%

Myoclonus in renal failure: Two cases of gabapentin toxicity

Kaufman

Parikh

Chan

et al. 2014

Epilepsy & Behavior Case Reports

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Gabapentin, an AED approved for the adjunctive treatment of partial seizures with/without secondary generalization and for the treatment of postherpetic neuralgia, is frequently used off-label for the treatment of both psychiatric and pain disorders. Since gabapentin is cleared solely by renal excretion, dosing requires consideration of the patient's renal function. Myoclonic activity may occur as a complication of gabapentin toxicity, especially with acute kidney injury or end-stage renal disease. We report 2 cases of myoclonic activity associated with gabapentin toxicity in the setting of renal disease which resolved with discontinuation of gabapentin and treatment with hemodialysis and peritoneal dialysis. As gabapentin has multiple indications and off-label uses, an understanding of myoclonus, neurotoxicity, and renal dosing is important to clinicians in multiple specialties.

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“…Since serotonin toxicity is generally related to the use of high doses of serotonergic drugs, the development of SS in our patient is rather unusual. However, SS cases associated with relatively low doses of serotonergic drugs were also reported [Pan and Shen, 2003; Turedi et al 2007].…”

Section: Discussionmentioning

confidence: 99%