Transient Brain Syndrome as a Non-Fatal Reaction to Combined Pargyline Imipramine Treatment

McCurdy, Robert; Kane, Francis J.

doi:10.1176/ajp.121.4.397

Cited by 16 publications

(1 citation statement)

References 6 publications

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“…The literature contains numerous reports of cases of serotonin syndrome secondary to the combination of an MAOI and a tricyclic antidepressant, 15,11,12,15,17,20,27,28,[67][68][69][70][71][72][73][74] Moclobemide is a reversible MAOI which is relatively selective for MAO-A. It was hoped that this drug would be less likely to be implicated in the serotonin syndrome, but one case was reported in association with a moclobemide/imipramine combination, [73] and a second following administration of moclobemide in combination with clomipramine,l27] The combination of an MAOI and tricyclic antidepressant causing serotonin syndrome is the only one that has been reported to cause seizures.…”

Section: Monoamine Oxidase Inhibitor (Maoi) and Tricyclic Antidepressmentioning

confidence: 99%

The Serotonin Syndrome

Sporer

1995

Drug Safety

183

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The serotonin syndrome has increasingly been recognised in patients who have received combined serotonergic drugs. This syndrome is characterised by a constellation of symptoms (confusion, fever, shivering, diaphoresis, ataxia, hyperelflexia, myoclonus or diarrhoea) in the setting of the recent addition of a serotonergic agent. The most common drug combinations causing the serotonin syndrome are monoamine oxidase inhibitors (MAOIs) and serotonin selective reuptake inhibitors (SSRIs), MAOIs and tricyclic antidepressants, MAOIs and tryptophan, and MAOIs and pethidine (meperidine). This syndrome is caused by excess serotonin (5-hydroxytryptamine; 5-HT) availability in the CNS at the 5-HT1A-receptor. There may also be some interaction with dopamine and 5-HT2-receptors. This syndrome probably has a low incidence, even among patients taking these drug combinations, and there is likely to be some other as yet unidentified inciting factor causing some patients to develop a full serotonin syndrome. Because fatalities and severe complications have accompanied the serotonin syndrome, the previously described drug combinations should be used cautiously or not at all. The serotonin syndrome is usually mild and, if managed with drug withdrawal and supportive therapy, generally improves within hours. Patients who develop hyperthermia should be treated aggressively with external cooling and paralysis. Methysergide and cyproheptadine appear to be useful adjuncts in treating the serotonin syndrome.

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