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Serotonin syndrome
induced by venlafaxine and fluoxetine: a case study in polypharmacy and
potential pharmacodynamic and pharmacokinetic
mechanisms.
Bhatara VS, Magnus RD, Paul KL,
Preskorn SH.
Child Psychiatry, University of South Dakota
School of Medicine, Sioux Falls, USA.
OBJECTIVE: To document a
case of serotonin syndrome associated with venlafaxine and fluoxetine
that did not involve a monoamine oxidase inhibitor, and to examine the
multiple factors, including pharmacodynamic and pharmacokinetic
interactions, that likely caused this adverse drug reaction (ADR). CASE
SUMMARY: A 39-year-old white woman with depression and panic attacks was
being treated with fluoxetine, trazodone, clonazepam, and cimetidine.
After fluoxetine and clonazepam were abruptly discontinued, venlafaxine
and lorazepam were started. Within 24 hours, she developed diaphoresis,
tremors, slurred speech, myoclonus, restlessness, impaired thinking, and
diarrhea. This constellation meets Sternbach's criteria for serotonin
syndrome. DISCUSSION: The possible contributors to this ADR are
discussed, including a single drug effect (e.g., an idiosyncratic
reaction to venlafaxine), a pharmacokinetic interaction, a
pharmacodynamic interaction, a combined pharmacokinetic-pharmacodynamic
interaction, and the patient' s panic disorder. CONCLUSIONS: As more
serotonergic drugs are developed and used for psychiatric disorders,
frequently in combination or close temporal proximity, clinicians must
be aware of and consider the factors that may increase the risk of
patients experiencing serotonin syndrome.
Publication Types:
PMID: 9562139 [PubMed - indexed for
MEDLINE]
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