Serotonin syndrome in advanced cancer patient treated with tramadol and antidepressants

Abstract

Serotonin syndrome is potentially life-threatening syndrome associated with excessive serotonergic activity within the central nervous system. Serotonin syndrome is associated with medication use, drug interactions, and overdose. While serotonin syndrome is often associated with the use of selective serotonin inhibitors (SSRI), an increasing number of reports are being presented involving the use of tramadol. With tramadol increasing popularity, the goal of this article is to make physicians more alert and aware of this potential side effect. Serotonin syndrome may be difficult to diagnose. A case of serotonin syndrome caused by the combination of tramadol and antidepressants in a patient with advanced cancer is presented and discussed. The importance of early diagnosis of this syndrome is emphasized.

Severe intoxication by psychotropic drugs; syndrome serotoninergic

“…7,8 This syndrome occurs mainly due to the administration of monoamine oxidase inhibitors such as tramadol in combination with SSRIs. Serotonergic activation in the central and peripheral nervous system is characterized by autonomic and neuromuscular mental dysfunctions and the 5'HT (hydroxytryptamine) receptors would be responsible for the symptomatology, besides serotonergic drugs are metabolized by cytochrome P 450 enzymes, therefore an alteration in these enzymes decreases the metabolism to some drugs and could have a tendency to the development of S.S. 9,10 In this pathology the diagnostic criteria could be determined by the presence of at least three of the ten clinical features such as agitation, tremor, mental status changes such as confusion, hypotonia, myoclonus, fever, hyporeflexia, diarrhea, diaphoresis. 6,10 Its recognition is directed to clinical perception, since the supporting diagnostic methods such as clinical laboratory and images do not provide definitive support, it is supported with parameters of clinical criteria of toxicity such as Sternbach, Hunter and Radomski, among these the Hunter criterion with a sensitivity of 84% and specificity of 97%.…”

Antidepressant and Anxiolytic Effect of Tramadol as Compared to Imipramine, in Acute and Chronic Dosage in Rats

“…Published evidence also claims that the antidepressant activity of tramadol (at a dose of 40mg/kg) surpasses that of fluoxetine in animal models. 20,21 Antidepressants (selective serotonin reuptake inhibitors; Venlafaxine), by virtue of their property of mood elevation and increasing the level of serotonin and consequently causing inhibition of release of transmitters carrying the pain sensation from nerve endings, are efficacious in chronic pain as an adjunctive treatment. Similarly, it could be inferred from our study that tramadol by acting through similar mechanism (inhibition of reuptake of monoamines leading to spinal inhibition of pain) might add moodelevation component to its analgesic effect.…”