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Severe serotonin
syndrome induced by mirtazapine
monotherapy.
Hernandez JL, Ramos FJ, Infante J,
Rebollo M, Gonzalez-Macias J.
Department of Internal
Medicine, Hospital Marques de Valdecilla, Santander, Spain.
joselhh@teleline.es
OBJECTIVE: To document a case of serotonin
syndrome (SS) associated with mirtazapine monotherapy, review the
previously reported cases of SS associated with this tetracyclic
antidepressant, and discuss the possible pathogenic mechanisms leading
to this serious adverse drug reaction. CASE SUMMARY: A 75-year-old man
developed agitation, confusion, incoordination, and gait disturbance
because of progressive rigidity. Mirtazapine had been started 8 days
earlier to control major depression. Physical examination revealed
diaphoresis, low-grade fever, hypertension, tachycardia, bilateral
cogwheel rigidity, hyperreflexia, tremor, and myoclonus, symptoms and
signs that are consistent with severe SS. DISCUSSION: A review of the
cases of SS with implication of mirtazapine as the cause was performed.
The possible pathogenic mechanisms leading to this adverse reaction in
this patient are also discussed, and pathophysiologic hypotheses are
formulated. CONCLUSIONS: Although mirtazapine offers clinicians a
combination of strong efficacy and good safety, we suggest bearing SS in
mind when prescribing this drug, especially in frail, elderly patients
with underlying chronic conditions. In these patients, it might be more
adequate to start mirtazapine therapy at a lower dose (<15
mg/d).
Publication Types:
PMID: 11918514 [PubMed - indexed for
MEDLINE]
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