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Comment in:
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Am J Emerg Med. 1995
Sep;13(5):605-7.
The serotonin syndrome
associated with paroxetine, an over-the-counter cold remedy, and vascular
disease.
Skop BP, Finkelstein JA,
Mareth TR, Magoon MR, Brown TM.
Department of Psychiatry, Wilford Hall Medical
Center, Lackland Air Force Base, TX 78236-5300.
There is a new,
potentially fatal disorder that is infrequently reported. The apparent rareness
may be because of a lack of recognition of the syndrome or its predisposing
factors. Fluoxetine (Prozac, Dista Products Co, Division of Eli Lilly Co,
Indianapolis, IN), sertraline (Zoloft, Roerig Division, Pfizer Inc, New York,
NY), and paroxetine (Paxil, SmithKline Beecham Pharmaceuticals, Philadelphia,
PA) belong to a new class of antidepressant medication: the serotonin
reuptake-inhibitors (SRIs). The relative safety profile of the SRIs has led to
their widespread use. However, a syndrome of excessive serotonergic activity,
the "serotonin syndrome" (SS), has recently been recognized. It is characterized
by changes in mental status, hypertension, restlessness, myoclonus,
hyperreflexia, diaphoresis, shivering, and tremor. A high index of suspicion is
required to make the diagnosis in these acutely ill patients. The most common
agents implicated in SS are the monoamine oxidase inhibitors in combination with
L-tryptophan or fluoxetine. A case of a patient with significant
peripheral vascular disease who developed SS while taking paroxetine and an
over-the-counter cold medicine is reported. There have been no prior reports of
this interaction. Discontinuation of the offending agents, sedation, and
supportive care are the mainstays of treatment. The interactions of serotonin
with platelets and vascular endothelium are also discussed.
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