Thursday, March 01, 2007

Serotonin Syndrome

Serotonin Syndrome A mix of medicines that can be lethal.
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Recognizing the early signs is tricky because it has varying symptoms that can be easily confused with less serious conditions, including tremor, diarrhea, high blood pressure, anxiety and agitation. The examining physician may regard early symptoms as inconsequential and may not think to relate them to drug therapy, Dr. Boyer and Dr. Shannon noted.

In its classic form, serotonin syndrome involves three categories of symptoms:

¶Cognitive-behavioral symptoms like confusion, disorientation, agitation, irritability, unresponsiveness and anxiety.

¶Neuromuscular symptoms like muscle spasms, exaggerated reflexes, muscular rigidity, tremors, loss of coordination and shivering.

¶Autonomic nervous system symptoms like fever, profuse sweating, rapid heart rate, raised blood pressure and dilated pupils.

Widespread ignorance of the syndrome is another diagnostic impediment. But even when doctors know about it, the strict diagnostic criteria may rule out “what are now recognized as mild, early or subacute stages of the disorder,” Dr. Boyer and Dr. Shannon wrote.

Perhaps adding to the diagnostic challenge is the fact that a huge number of drugs — prescription, over the counter, recreational and herbal — can trigger the syndrome. In addition to selective serotonin reuptake inhibitors like Zoloft, Prozac and Paxil and serotonin/norepinephrine reuptake inhibitors like Effexor, the list includes tricyclic antidepressants and MAOIs (for monoamine oxidase inhibitors); narcotic painkillers like fentanyl and tramadol; over-the-counter cough and cold remedies containing dextromethorphan; the anticonvulsant valproate; triptans like Imitrex used to treat and prevent migraines; the antibiotic Zyvox (linezolide); antinausea drugs; the anti-Parkinson’s drug L-dopa; the weight-loss drug Meridia (sibutramine); lithium; the dietary supplements tryptophan, St. John’s wort and ginseng; and several drugs of abuse, including ecstasy, LSD, amphetamines, the hallucinogens foxy methoxy and Syrian rue.
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