Multiple drug interactions - induced serotonin syndrome: a case report

Abstract

Serotonin syndrome is a potentially life-threatening disorder of excessive serotoninergic activity often due to drug interactions. We report a case of serotonin syndrome induced by pharmacokinetic and pharmacodynamic interactions between three different selective serotonin-reuptake inhibitors (SSRI) and possibly ciprofloxacin. Extreme caution is necessary in patients treated with serotonin-reuptake inhibitors who need to be switched to another antidepressant or when they require the addition of concomitant drugs, especially serotoninergic drugs and isoenzimes of cytochrome P450 inhibitors.

Quinolone antibiotics and suicidal behavior: analysis of the World Health Organization’s adverse drug reactions database and discussion of potential mechanisms

“…The potential risk of suicidal behaviors and more generally for neuropsychiatric adverse effects associated with quinolones has been suggested by several case reports (Tomé and Filipe, 2011;Behera et al, 2013;Labay-Kamara et al, 2012;Barthélémi and Lebrun, 2015;Ahmed et al, 2011;Lasalvia et al, 2010, Montané et al, 2009Mulhall and Bergman, 1995;Feinberg, 1995). Quinolones were associated with various neuropsychiatric adverse drug reactions, including delirium, agitation, confusion, psychosis, seizures/convulsions, anxiety and major depression (Melhorn and Brown, 2007;Dukes, 2006;Feinberg, 1995;Fish, 2001).…”

Fluoroquinolones, the Cornerstone of Treatment of Drug-Resistant Tuberculosis: A Pharmacokinetic and Pharmacodynamic Approach

“…In addition, in bone marrow and kidney transplant patients, no extra monitoring is necessary when MFX is given to patients who already received tacrolimus or cyclosporine (332;333). However, several FQ-induced adverse effects were reported possibly due to CYP3A4 inhibition by CFX, including QT prolongation, serotonergic effects, hypoglycemia and rhabdomyolysis upon simultaneous treatment with azimilide, citalopram, glyburide and simvastatine, respectively (334)(335)(336)(337). Hypoglycemia was also observed after treatment of LFX with glipizide, but more recently severe effects on glucose homeostasis were only reported after a combination of GFX with different antidiabetic agents (i.e.…”

Drug Interaction and Pharmacist

“…[2] Serotonin syndrome is a potentially life-threatening disorder of excessive serotoninergic activity often due to drug interactions. [3] Many other drugs act as precipitants or objects, and a number of drugs act as both. [2] An overview of selected serious drug interactions is given in Table 1.…”