Serotonin toxicity: a short review of the literature and two case reports involving Citalopram

The serotonin toxicity (ST) is a potentially life-threatening adverse drug reaction results from therapeutic drug use, intentional self-poisoning, or inadvertent interactions between drugs. ST can be caused by a single or a combination of drugs with serotonergic activity due to excessive serotonergi...

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Bibliographic Details
Published in:Neurological sciences 2011-06, Vol.32 (3), p.507-509
Main Authors: Talarico, G., Tosto, G., Pietracupa, S., Piacentini, E., Canevelli, M., Lenzi, G. L., Bruno, G.
Format: Article
Language:English
Subjects:
Aged
Case Report
Cimetidine - administration & dosage
Cimetidine - adverse effects
Citalopram - administration & dosage
Citalopram - adverse effects
Cytochrome P-450 CYP2D6 - physiology
Cytochrome P-450 CYP2D6 Inhibitors
Female
Fructose - administration & dosage
Fructose - adverse effects
Fructose - analogs & derivatives
Humans
Male
Medicine
Medicine & Public Health
Neurology
Neuroradiology
Neurosciences
Neurosurgery
Psychiatry
Serotonin Syndrome - chemically induced
Serotonin Syndrome - diagnosis
Serotonin Syndrome - metabolism
Serotonin Uptake Inhibitors - administration & dosage
Serotonin Uptake Inhibitors - adverse effects
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Summary:The serotonin toxicity (ST) is a potentially life-threatening adverse drug reaction results from therapeutic drug use, intentional self-poisoning, or inadvertent interactions between drugs. ST can be caused by a single or a combination of drugs with serotonergic activity due to excessive serotonergic agonism on central nervous system and peripheral serotonergic receptors (monoamine oxidase inhibitors, tricyclic antidepressants, SSRIs, opiate analgesics, over-the-counter cough medicines, antibiotics, weight-reduction agents, antiemetics, antimigraine agents, drugs of abuse, H2-antagonist and herbal products). The serotonin toxicity is often described as a clinical triad of mental-status changes (agitation and excitement with confusion), autonomic hyperactivity (diaphoresis, fever, tachycardia, and tachypnea), neuromuscular abnormalities (tremor, clonus, myoclonus, and hyperreflexia) and, in the advanced stage, spasticity; not all of these findings are consistently present. In this article, we describe two cases of ST due to interaction between Citalopram and two CYP2D6 inhibitors: Cimetidine and Topiramate and their clinical resolution after treatment discontinuation.
ISSN:1590-1874
1590-3478
DOI:10.1007/s10072-011-0546-z