Serotonin Syndrome Due to Duloxetine

The serotonin syndrome is a serioius medical condition due due to an intensive stimulation of setonin receptors. It is a rare, but severe, consequence of interaction between serotomimetic agents. This is a report of a 70-year-old woman steadily in therapy with venlafaxine and rizatriptan for migraine and major depressive syndrome. She was admitted to neurology unit for decreased light reflex with miotic pupils, global hyperreflexia, tremor, anxiety, ataxia and incoordination. The patient was diagnosed as a probable case of serotonin syndrome due to a pharmacological interaction between venlafaxine and rizatriptan trigged by opioid intake. In this paper, the development of syntomatology, the clinical examination and the possible pharmacokinetics explanation were carefully discussed and analysed.

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“… 22) In humans the increased risk of developing the SS is hypothesized by Gelener et al . 10) with a possible serotonin transporter polymorphism.…”

Section: Discussionmentioning

confidence: 99%

“… 9) The SS is caused by the serotonergic agent’s use and it usually occurs within 24 hours after the serotomimetic drugs intake. 8 – 10) Abadie et al . 11) described the mostly involved medicines in SS, based on the French pharmacovigilance reports; SSRIs seem to be involved in 42.1% and SNRIs (mainly venlafaxine) in 9.1%.…”

Section: Introductionmentioning

confidence: 99%

Codeine Precipitating Serotonin Syndrome in a Patient in Therapy with Antidepressant and Triptan

Milano

Natta

Bello

et al. 2017

Clin Psychopharmacol Neurosci

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“…No other medications or information on the patient's medication and medical histories were available. The ED physician evaluated the patient and documented a Glasgow Coma Score of 8 (normal range, [13][14][15], normal heart sounds, positive bowel sounds, tremor, and hyperreflexia. An electrocardiogram (EKG) was interpreted as sinus tachycardia with narrow QRS complexes and a QTc of 454 ms. Vital signs 35 minutes after ED arrival were BP 166/100 mm Hg, HR 123 beats/ min, RR 27 breaths/min, O 2 sat 100%, and a temporal temperature of 100.2°F.…”

Section: Case Reportmentioning

confidence: 99%

“…11,13 Among all the medications the patient was taking, only duloxetine, amitriptyline, and tapentadol are associated with the development of serotonin syndrome. 14,15 Application of the Naranjo adverse reaction probability nomogram (Table 3) yields a score of 7, indicating a probable temporal and causal relationship between tapentadol and serotonin syndrome. 16 A comprehensive literature search was conducted using Ovid MEDLINE and PubMed (1950-October 2015).…”

Section: Review Of the Case And Literature Searchmentioning

confidence: 99%

Probable Tapentadol-Associated Serotonin Syndrome after Overdose

et al. 2016

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Purpose: Drug-induced serotonin syndrome is a potentially life-threatening condition. An Ovid MEDLINE, and PubMed search from 1950 to October 2015 revealed one published case report of suspected tapentadol-induced serotonin syndrome. We report a probable case of tapentadolinduced serotonin syndrome after overdose. Case Summary: A 48-year-old male was found unresponsive after a witnessed overdose of medications including tapentadol. After administration of naloxone by emergency medical services, the patient became combative and presented with altered mental status. He was managed with physical and pharmacologic restraints in the emergency department. Other medications that could be implicated in the patient's presentation include duloxetine and amitriptyline. It was suspected that the opioid properties of tapentadol were masking the patient's signs and symptoms of serotonin syndrome. The patient was admitted to the medical intensive care unit, remained stable, and was discharged 2 days later. Currently, there is one published case report of suspected tapentadolinduced serotonin syndrome after an overdose. The manufacturer of tapentadol reported no cases of serotonin syndrome during clinical trials, but there have been postmarketing cases reported with co-administration of other serotonergic drugs. Conclusion:We report a probable case of tapentadol-induced serotonin syndrome after overdose. Further research is needed to better understand the pharmacology and incidence behind this adverse event.

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“…These include monoamine oxidase inhibitors (MAOIs), tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), opioid analgesics, antibiotics, antiemetics, and herbal products [1]. Serotonin-norepinephrine reuptake inhibitors (SNRIs)-induced serotonin syndrome is rare, and occurs mainly with co-administration of SSRIs or opioids [2][3][4]. Symptoms range from mild to life-threatening, with signs of excess serotonin ranging from tremor and diarrhea in mild cases to delirium, neuromuscular rigidity, and hyperthermia in life-threatening cases.…”

Section: Introductionmentioning

confidence: 99%

Serotonin Syndrome following Duloxetine Administration in a Fibromyalgia Patient: Case Report and Literature Review

et al. 2016

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Serotonin syndrome, an adverse drug reaction, is a consequence of excess serotonergic agonism of central nervous system receptors and peripheral serotonergic receptors. Serotonin syndrome has been associated with large numbers of drugs and drug combinations, and serotonin-norepinephrine reuptake inhibitor-induced serotonin syndrome is rare. It is often described as a sign of excess serotonin ranging from tremor in mild cases to delirium, neuromuscular rigidity, and hyperthermia in life-threatening cases. Diagnosis is based on the symptoms and patient's history, and several diagnostic criteria have been developed. We experienced a rare case of fibromyalgia accompanied by tremor, hyperreflexia, spontaneous clonus, muscle rigidity, and diaphoresis after 10 days of single use of duloxetine 30 mg. Only one case of serotonin syndrome resulting from administration of duloxetine has been reported in Korea, however that case resulted from co-administration of fluoxetine. We report here on this case along with a review of the relevant literature. (J Rheum Dis 2016;23:332-335)

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Serotonin Syndrome Due to Duloxetine

Cited by 24 publications

References 3 publications

Codeine Precipitating Serotonin Syndrome in a Patient in Therapy with Antidepressant and Triptan

Codeine Precipitating Serotonin Syndrome in a Patient in Therapy with Antidepressant and Triptan

Probable Tapentadol-Associated Serotonin Syndrome after Overdose

Serotonin Syndrome following Duloxetine Administration in a Fibromyalgia Patient: Case Report and Literature Review

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