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2.
BMJ Case Rep ; 13(1)2020 Jan 21.
Artigo em Inglês | MEDLINE | ID: mdl-31969414

RESUMO

A young man was using dihydrocodeine analgesia for ear pain having had suppurative otitis media. He attended the emergency department with restlessness and twitching movements in his arms and legs. He had fever with otherwise normal vital signs. He had no signs of cerebellar pathology. Investigations were normal. The working diagnosis was of hyperkinetic reaction to dihydrocodeine. Symptoms resolved within 48 hours of withdrawing the drug. Serotonin toxicity is a rare side effect of dihydrocodeine. There is a theoretical basis for increased side effects when taken with cannabidiol-based substances.


Assuntos
Analgésicos Opioides/efeitos adversos , Codeína/análogos & derivados , Hipercinese/induzido quimicamente , Síndrome da Serotonina/induzido quimicamente , Adulto , Codeína/efeitos adversos , Diagnóstico Diferencial , Humanos , Masculino , Otite Média/tratamento farmacológico
3.
Am J Emerg Med ; 38(8): 1695.e5-1695.e6, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-31837902

RESUMO

Serotonin syndrome (SS) is a rare, potentially life-threatening adverse drug reaction. Selective serotonin reuptake inhibitors (SSRIs) are among a number of pharmaceuticals that all contribute to SS, but SS caused by SSRI monotherapy is rare. We present a case of probable sertraline-induced SS. A 36-year-old male presented to the emergency department four times in one week with a constellation of autonomic and neuromuscular symptoms. He had been taking sertraline at a therapeutic dose for less than three months. Moderate SS was diagnosed using the Hunter criteria during the fourth visit, when it was seen that he had hyperreflexia and inducible ankle clonus. The patient's symptoms resolved within 24 hours with lorazepam, intravenous fluids, and discontinuation of sertraline. In the emergency department it is important to have a high clinical suspicion for SS even if the patient is taking SSRI monotherapy at therapeutic doses.


Assuntos
Síndrome da Serotonina/diagnóstico , Inibidores de Captação de Serotonina/efeitos adversos , Sertralina/efeitos adversos , Adulto , Ansiolíticos/uso terapêutico , Ansiedade/induzido quimicamente , Ansiedade/tratamento farmacológico , Humanos , Lorazepam/uso terapêutico , Masculino , Síndrome da Serotonina/induzido quimicamente , Síndrome da Serotonina/tratamento farmacológico , Inibidores de Captação de Serotonina/uso terapêutico , Sertralina/uso terapêutico
4.
Psiquiatr. biol. (Internet) ; 26(3): 113-115, sept.-dic. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-191662

RESUMO

INTRODUCCIÓN: El síndrome serotoninérgico es un cuadro clínico debido a altos niveles de serotonina. Está causado por el uso de uno o varios fármacos con actividad serotoninérgica de forma concomitante. Su diagnóstico es clínico y se lleva a cabo según criterios diagnósticos. CASO CLÍNICO: Paciente de 65años en seguimiento de larga evolución por trastorno afectivo bipolar con reciente instauración de tratamiento con amitriptilina. En urgencias se observa temblor distal, ataxia, bradipsiquia, desorientación temporoespacial, discinesia orolingual, miocolonías oculares y diaforesis. Se descartan posibles etiologías causantes del cuadro. RESULTADOS: Apareció un síndrome serotoninérgico tras la instauración de amitriptilina. No fueron necesarias medidas invasivas de soporte. Se retiró el tratamiento con psicofármacos y se instauraron progresivamente aquellos sin actividad serotoninérgica. CONCLUSIONES: No es necesario el uso concomitante de varios fármacos serotoninérgicos, sino que puede aparecer este síndrome con el uso de un fármaco instaurado de forma brusca


INTRODUCTION: Serotoninergic syndrome is a clinical disorder due to high levels of serotonin. It is caused by the concomitant use of one or several drugs with high serotoninergic activity. Its diagnosis is clinical, and is made following some diagnostic criteria. CLINICAL CASE: The case concerns a 65 year-old patient on long-term follow due to a bipolar affective disorder, and who recently started treatment with amitriptyline. In the Emergency Department, distal tremor was observed, as well as ataxia, bradypsychia, time-space orientation, orolingual dyskinesia, ocular myoclonus, and diaphoresis. Possible aetiological causes of the syndrome were ruled. RESULTS: A serotoninergic syndrome appeared after starting amitriptyline treatment. Invasive support measures were not necessary. The treatment with psychiatric drugs was withdrawn and gradually started with those without serotoninergic activity. CONCLUSIONS: The concomitant use of several serotoninergic drugs is not necessary, although this syndrome can appear with the use of a suddenly introduced drug


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Idoso , Síndrome da Serotonina/induzido quimicamente , Transtorno Bipolar/tratamento farmacológico , Amitriptilina/efeitos adversos , Síndrome da Serotonina/diagnóstico , Serotoninérgicos/administração & dosagem , Índice de Gravidade de Doença , Inibidores de Captação de Serotonina/uso terapêutico
5.
CNS Neurol Disord Drug Targets ; 18(10): 758-768, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31721720

RESUMO

Tramadol is a synthetic analog of codeine used to treat pain of moderate to severe intensity and is reported to have neurotoxic potential. At therapeutic dose, tramadol does not cause major side effects in comparison to other opioid analgesics, and is useful for the management of neurological problems like anxiety and depression. Long term utilization of tramadol is associated with various neurological disorders like seizures, serotonin syndrome, Alzheimer's disease and Parkinson's disease. Tramadol produces seizures through inhibition of nitric oxide, serotonin reuptake and inhibitory effects on GABA receptors. Extensive tramadol intake alters redox balance through elevating lipid peroxidation and free radical leading to neurotoxicity and produces neurobehavioral deficits. During Alzheimer's disease progression, low level of intracellular signalling molecules like cGMP, cAMP, PKC and PKA affect both learning and memory. Pharmacologically tramadol produces actions similar to Selective Serotonin Reuptake Inhibitors (SSRIs), increasing the concentration of serotonin, which causes serotonin syndrome. In addition, tramadol also inhibits GABAA receptors in the CNS has been evidenced to interfere with dopamine synthesis and release, responsible for motor symptoms. The reduced level of dopamine may produce bradykinesia and tremors which are chief motor abnormalities in Parkinson's Disease (PD).


Assuntos
Doença de Parkinson Secundária/induzido quimicamente , Convulsões/induzido quimicamente , Síndrome da Serotonina/induzido quimicamente , Tramadol/efeitos adversos , Analgésicos Opioides/efeitos adversos , Animais , Humanos
7.
A A Pract ; 13(11): 420-422, 2019 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-31577540

RESUMO

Perioperative serotonin syndrome has been associated with a number of medications and herbal supplements. We report a patient who developed serotonin syndrome immediately after an endoscopic procedure in which the preoperative use of black seed oil appears to have played a role in stimulating the syndrome. Black seed oil has not been previously reported in association with perioperative serotonin syndrome. Anesthesia professionals should be aware that patients taking black seed oil supplements may develop serotonin syndrome postoperatively.


Assuntos
Óleos Vegetais/efeitos adversos , Síndrome da Serotonina/induzido quimicamente , Adulto , Endoscopia , Humanos , Masculino , Naloxona/uso terapêutico , Período Perioperatório , Óleos Vegetais/química , Síndrome da Serotonina/tratamento farmacológico
9.
J Forensic Sci ; 64(6): 1950-1952, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31643086

RESUMO

4-bromo-2,5-dimethoxyphenethylamine (2C-B) is a designer drug. In Europe, 2C-B is easily obtained and used for recreational purposes. It is known for its stimulating effects similar to those of 3,4-methylenedioxymethamphetamine, although in higher doses it has more hallucinogenic effects. Here, we report a case of 2C-B ingestion, confirmed by liquid chromatography-tandem mass spectrometry, in an 18-year-old man. The neurological consequences were severe, including the development of serotonin syndrome and severe brain edema. Supportive therapy resulted in a stable condition, although, after several months, the patient still suffered from severe neurological impairment due to the drug-induced toxicity. This case showed that 2C-B could not be identified with the drugs of abuse screening routinely used in Dutch hospitals. The use of 2C-B carries many risks, with potentially profound neurological damage, that both consumers and healthcare physicians are unaware of.


Assuntos
Edema Encefálico/induzido quimicamente , Drogas Desenhadas/efeitos adversos , Dimetoxifeniletilamina/efeitos adversos , Convulsões/induzido quimicamente , Síndrome da Serotonina/induzido quimicamente , Adolescente , Cromatografia Líquida , Humanos , Masculino , Transtornos Relacionados ao Uso de Substâncias/complicações , Espectrometria de Massas em Tandem
11.
J Psychiatr Pract ; 25(4): 290-297, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31291209

RESUMO

This column is the sixth in a series exploring drug-drug interactions (DDIs) with a special emphasis on psychiatric medications. The first 3 columns in this DDI series discussed why patients being treated with psychiatric medications are at increased risk for taking multiple medications and thus experiencing DDIs, how to recognize such DDIs, strategies for avoiding and/or minimizing adverse outcomes from such DDIs, and pharmacokinetic considerations concerning DDIs in psychiatric practice. The fourth and fifth columns in this series presented a pair of parallel tables, one of which outlined the primary, known mechanism(s) of action of all commonly used psychiatric medications and one of which summarized major types of pharmacodynamic DDIs based on mechanism of action. Clinicians can use these 2 tables together to predict pharmacodynamically mediated DDIs. This sixth column in the series discusses some key issues related to pharmacodynamic interactions involving commonly used psychiatric medications. The column first discusses 3 types of pharmacological agents that deserve special mention because of the widespread types of pharmacodynamic DDIs they can have with psychiatric and other medications: ethanol, opioids, and monoamine oxidase inhibitors, with a special focus on hypertensive crises and serotonin syndrome with monoamine oxidase inhibitors. The column also discusses DDIs in terms of effects on the cardiovascular system, including QTc prolongation, blood pressure and heart rate regulation, increased risk of bleeding and abnormal bleeding, and valvular heart disease, and on the central nervous system, including increased sedation, respiratory depression, body temperature regulation, and tardive dyskinesia. The overall goal of this series of columns is to present a simple way of conceptualizing neuropsychiatric medications in terms of their pharmacodynamics and pharmacokinetics to allow prescribers to take these facts into consideration when they need to use more than 1 drug in combination to optimally treat a patient.


Assuntos
Transtornos Mentais/tratamento farmacológico , Psicotrópicos/farmacologia , Interações Medicamentosas , Etanol/efeitos adversos , Etanol/farmacologia , Humanos , Hipertensão/induzido quimicamente , Síndrome do QT Longo/induzido quimicamente , Inibidores da Monoaminoxidase/efeitos adversos , Inibidores da Monoaminoxidase/farmacologia , Inibidores da Monoaminoxidase/uso terapêutico , Alcaloides Opiáceos/efeitos adversos , Alcaloides Opiáceos/farmacologia , Alcaloides Opiáceos/uso terapêutico , Psicotrópicos/uso terapêutico , Síndrome da Serotonina/induzido quimicamente , Discinesia Tardia/induzido quimicamente
13.
Ned Tijdschr Geneeskd ; 1632019 02 07.
Artigo em Holandês | MEDLINE | ID: mdl-30816647

RESUMO

Serotonin syndrome is a medication-induced clinical syndrome, caused by an increased concentration of serotonin in the central and peripheral nervous system. An excess of serotonin can be caused by the use of one or more serotinergic substances on the one hand, or by decreased clearance of these substances on the other hand We carried out a systematic literature search to make an estimation of substances and patient-related factors that might be associated with an increased risk of serotonin syndrome. We also carried out a search for all reports of serotonin syndrome in the Lareb (Netherlands pharmacovigilance centre) database. Patient-centred medication monitoring is not yet possible because there is an almost complete lack of clinical predictors. For the time being, all that treatment providers can do to help recognise serototin syndrome on time is to be extra alert in patients belonging to risk groups (the elderly, or patients with renal or hepatic insufficiency.


Assuntos
Farmacovigilância , Síndrome da Serotonina/induzido quimicamente , Adulto , Sistemas de Notificação de Reações Adversas a Medicamentos , Idoso , Bases de Dados Factuais , Monitoramento de Medicamentos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos , Publicações , Fatores de Risco
15.
Clin Neuropharmacol ; 42(3): 103-104, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30844852

RESUMO

BACKGROUND: We report on the serotonin syndrome after an alcohol intake in a patient with major depressive disorder treated with escitalopram and clomipramine. CASE: A 26-year-old male patient with major depressive disorder had been stable on the treatment with escitalopram (20 mg/d) and clomipramine (50 mg/d) for 4 months. He had rarely taken alcohol, especially never with medication. One night after taking these drugs with a can of beer, he developed agitation, disorientation, myoclonus, hyperreflexia, tremor, tachycardia, diaphoresis, and hypertension, fulfilling the criteria for the serotonin syndrome. It was considered that the serotonin syndrome in the present case might be induced by alcohol's pharmacodynamic interaction with escitalopram and clomipramine leading to decreased clearance of extracellular serotonin in the brain and/or pharmacokinetic interaction with clomipramine leading to increased clomipramine levels. CONCLUSIONS: The present case report suggests that there may be an interaction between alcohol and antidepressants resulting in the serotonin syndrome, and clinicians should be aware of this possibility.


Assuntos
Consumo de Bebidas Alcoólicas/efeitos adversos , Citalopram/efeitos adversos , Clomipramina/efeitos adversos , Síndrome da Serotonina/induzido quimicamente , Inibidores de Captação de Serotonina/efeitos adversos , Adulto , Antidepressivos/efeitos adversos , Transtorno Depressivo Maior/tratamento farmacológico , Interações Medicamentosas , Humanos , Masculino
16.
Medicine (Baltimore) ; 98(13): e15057, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30921235

RESUMO

RATIONALE: Takotsubo cardiomyopathy (TC) is characterized by transient left ventricular dysfunction. We describe a patient with stroke who presented with TC caused by serotonin syndrome (SS) following the administration of serotonergic and dopaminergic agents. PATIENT CONCERNS: A 55-year-old man with stroke was administered venlafaxine, tianeptine, ropinirole, carbidopa/levodopa, bromocriptine, and methylphenidate during rehabilitation. The patient presented with clinical features of SS (mental confusion, agitation, hyperhidrosis, chills, rigidity, and tachycardia), which persisted over 24 hours. The day after his SS symptoms disappeared, the patient's blood pressure decreased, and he developed tachycardia. DIAGNOSES: Echocardiography revealed an extensively akinetic apical segment and a severely hypokinetic midventricular segment of the left ventricle with basal hyperkinesia. The ejection fraction was reduced to 38%, and he was diagnosed with TC by the cardiologist. INTERVENTIONS: He was administered oxygen at 8 to 10 L/minutes via a Venturi mask, and norepinephrine bitartrate was administered intravenously. Hydration was maintained with normal saline infusion. OUTCOMES: Following appropriate management of TC, the patient was hemodynamically stable with significant recovery of his left ventricular wall motion. LESSONS: Prognosis of TC is usually favorable; however, it could be fatal in some cases. Clinicians should be aware of the potential development of TC in patients with stroke presenting with SS following the administration of serotonergic and dopaminergic agents.


Assuntos
Síndrome da Serotonina/induzido quimicamente , Inibidores da Recaptação de Serotonina e Norepinefrina/efeitos adversos , Acidente Vascular Cerebral/tratamento farmacológico , Cardiomiopatia de Takotsubo/induzido quimicamente , Humanos , Masculino , Pessoa de Meia-Idade
17.
World Neurosurg ; 126: 261-263, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30898741

RESUMO

BACKGROUND: Serotonin syndrome (SS) is a common disease entity and could result in death if missed. The incidence of SS is underestimated due to misdiagnosis of many cases, especially the ones with less severe presentation. Many medications have been depicted as the source of SS. We present a case of SS in a patient who received intravenous tramadol and oral gabapentin as pain management after spine surgery. CASE DESCRIPTION: A 66-year-old man was admitted to our outpatient clinic with walking difficulties for 2 months. He was neurologically intact. However, he had neurologic claudication. He was on insulin, telmisartan-hydrochlorothiazide, amlodipine, and albuterol before the surgery, and these drugs were continued after the surgery. After he was diagnosed with lumbar spinal stenosis, he underwent total laminectomies of L3 and L4 and bilateral transpedicular screw placement from L1 to L5. He received tramadol 100 mg once daily intravenously and gabapentin 300 mg thrice daily orally after the spine surgery. He became confused, aggressive, and agitated during his stay in the hospital postoperatively. He became frustrated with even his children and wife. He started receiving haloperidol and quetiapine after psychiatry consultation. Because he worsened immediately after quetiapine and haloperidol, his medications were ceased in a step-by-step manner (first, tramadol and second, gabapentin). He became stable in a few hours, and his symptoms have improved since then. CONCLUSIONS: Physicians treating spine patients should be alert about SS in patients using both tramadol and gabapentin.


Assuntos
Analgésicos/efeitos adversos , Gabapentina/efeitos adversos , Dor Pós-Operatória/tratamento farmacológico , Síndrome da Serotonina/induzido quimicamente , Tramadol/efeitos adversos , Idoso , Analgésicos/uso terapêutico , Gabapentina/uso terapêutico , Humanos , Laminectomia , Masculino , Fusão Vertebral , Estenose Espinal/cirurgia , Tramadol/uso terapêutico
18.
Forensic Sci Med Pathol ; 15(2): 258-261, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30796754

RESUMO

Drugs for the treatment of depressive disorders, including SNRIs (serotonin noradrenaline reuptake inhibitors) venlafaxine and duloxetine, are widely prescribed as they have a high therapeutic to toxicity ratio. In rare cases, adverse effects may be severe, usually due to iatrogenic, accidental or intentional self-overdose that cause the excessive accumulation of serotonin and noradrenaline in synaptic clefts. Lethal intoxication with a combination of venlafaxine and duloxetine (postmortem blood concentrations 24 mg/L and 0.97 mg/L, respectively) without co-ingested substances, comorbidities or injuries that could have an unknown contribution to a fatal outcome is presented for the first time in the following case report, with a comprehensive clinical history, and complete results of the performed analyses. The cause of death was a serotonin syndrome that progressed to death in approximately six hours and 15 min after the suicidal ingestion of venlafaxine and duloxetine. Despite the high therapeutic to toxicity ratio SNRIs, which are reserved for patients with severe forms of depressive disorders and a higher suicidal tendency, they should be cautiously prescribed and handed over in smaller packages to make them easier to follow, and thus avoid accumulation within the patient's reach.


Assuntos
Cloridrato de Duloxetina/envenenamento , Síndrome da Serotonina/induzido quimicamente , Inibidores da Recaptação de Serotonina e Norepinefrina/envenenamento , Cloridrato de Venlafaxina/envenenamento , Adulto , Overdose de Drogas , Cloridrato de Duloxetina/análise , Feminino , Humanos , Inibidores da Recaptação de Serotonina e Norepinefrina/análise , Suicídio , Cloridrato de Venlafaxina/análise
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