scholarly journals Tramadol, Pharmacology, Side Effects, and Serotonin Syndrome: A Review

2015 ◽  
Vol 18;4 (4;18) ◽  
pp. 395-400
Author(s):  
Alan David Kaye
Keyword(s):  
Side Effects ◽  
Drug Interactions ◽  
Serotonin Syndrome ◽  
Potential Side Effect ◽  
Serotonergic Activity ◽  
Potential Abuse ◽  
Life Threatening ◽  
The Central Nervous System ◽  
Physician Reviews ◽  
Serotonergic Drugs

Background: Serotonin syndrome is a mild to potentially life-threatening syndrome associated with excessive serotonergic activity within the central nervous system. Serotonin syndrome is associated with medication use, drug interactions, and overdose. While serotonin syndrome is often associated with the use of selective serotonin inhibitors (SSRI), an increasing number of reports are being presented involving the use of tramadol. Methods: This review article contains an overview of serotonin syndrome while specifically looking at tramadol’s pharmacology and risk factors for serotonin syndrome. With tramadol’s increasing popularity, the goal of this article is to make physicians more alert and aware of this potential side effect associated with tramadol. Conclusions: In conclusion, with the increasing incidence of serotonin syndrome, prescribing physicians should be aware of and educate their patients on the potential side effects of tramadol. It is important that the prescribing physician reviews patient medications for concurrent serotonergic drugs and monitors for potential abuse. Key words: Tramadol, serotonin syndrome, drug interactions, analgesics

scholarly journals Serotonin Syndrome with Escitolapram and Concomitant Use of Cocaine: A Case Report

2012 ◽  
Vol 5 ◽  
pp. CCRep.S9540 ◽  
Author(s):  
Hamood Ur-Rehman Malik ◽  
Krishan Kumar
Keyword(s):  
Serotonin Syndrome ◽  
Mental Illnesses ◽  
Drug Abusers ◽  
Serotonergic Activity ◽  
Psychotropic Agents ◽  
Threatening Condition ◽  
Autonomic Instability ◽  
Life Threatening ◽  
The Central Nervous System ◽  
Serotonergic Drugs

Introduction Serotonin syndrome is a potentially life-threatening condition caused by excessive serotonergic activity in the central nervous system. It is characterized by mental status changes (eg, confusion, agitation, lethargy, coma), autonomic instability (eg, hyperthermia, tachycardia, diaphoresis, nausea, vomiting, diarrhea, dilated pupils), and neuromuscular hyperactivity (eg, myoclonus, hyperreflexia, rigidity, trismus). Serotonin syndrome classically occurs in patients receiving two or more serotonergic drugs, but it can occur with monotherapy. We report a case of a 20-year-old man who developed serotonin syndrome resulting from overdose of Escitolapram with concomitant use of cocaine. It is a very important area in medicine as serotonin syndrome should be suspected especially in drug abusers who are being treated with psychotropic agents for mental illnesses.

scholarly journals Serotonin Syndrome in the Setting of Lamotrigine, Aripiprazole, and Cocaine Use

2015 ◽  
Vol 2015 ◽  
pp. 1-3 ◽  
Author(s):  
Anupam Kotwal ◽  
Sarah L. Cutrona
Keyword(s):  
Cocaine Abuse ◽  
Serotonin Syndrome ◽  
Pharmacodynamic Interactions ◽  
Serotonergic Activity ◽  
Threatening Condition ◽  
Neuromuscular Abnormalities ◽  
Life Threatening ◽  
The Central Nervous System ◽  
Autonomic Hyperactivity ◽  
Toxicity Criteria

Serotonin syndrome is a potentially life-threatening condition associated with increased serotonergic activity in the central nervous system. It is classically associated with the simultaneous administration of two serotonergic agents, but it can occur after initiation of a single serotonergic drug or increasing the dose of a serotonergic drug in individuals who are particularly sensitive to serotonin. We describe a case of serotonin syndrome that occurred after ingestion of higher than prescribed doses of lamotrigine and aripiprazole, in addition to cocaine abuse. The diagnosis was established based on Hunter toxicity criteria and severity was classified as mild. The features of this syndrome resolved shortly after discontinuation of the offending agents. Serotonin syndrome is characterized by mental status changes, autonomic hyperactivity, and neuromuscular abnormalities along a spectrum ranging from mild to severe. Serotonin syndrome in our patient was most likely caused by the pharmacokinetic and pharmacodynamic interactions between lamotrigine, aripiprazole, and cocaine leading to increased CNS serotonergic activity.

Effectiveness and safety of modern treatment against nausea and vomiting induced by chemotherapy and radiotherapy

2021 ◽  
Vol 14 (1) ◽  
pp. 11-15
Author(s):  
Łukasz Hajac ◽  
Martyna Hajac ◽  
Adam Maciejczyk
Keyword(s):  
Side Effects ◽  
Serotonin Syndrome ◽  
Nausea And Vomiting ◽  
Effective Prevention ◽  
Important Group ◽  
Life Threatening ◽  
Treatment Changes ◽  
Long Acting ◽  
Methods Of Treatment

Nausea and vomiting are one of most frequent side effects of chemotherapy and radiotherapy. Effective prevention and treatment of these symptoms is essential for better quality of life for patients undergoing oncological therapies. Nausea and vomiting can be acute, delayed or anticipatory. Leading mechanisms and methods of treatment are different for each of those. Most often used groups of drugs are: 5-HT3-antagonists, glucocorticosteroids, NK1-antagonists. Another important group are neuroleptics, which are therapy of choice for anticipatory vomiting. Modern antiemetic medications are in most cases safe and effective. But as every treatment it causes risks of adverse events which may be serious and difficult to manage. It applies in particular to long-acting drugs. Most common side effects are headache, constipation and sedation. But more severe or life-threatening symptoms may appear, like intestinal obstruction and serotonin syndrome. Some of the drugs also come with risk of interacting with other treatment. Changes in pharmacokinetics may lead to additional toxicities. In elderly, especially with cardiac disease, in risk of ileus or cachexia these drugs shall be used with caution.

Serotonin Syndrome

2019 ◽  
pp. 467-471
Author(s):  
Kevin T. Gobeske ◽  
Eelco F. M. Wijdicks
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Autonomic Nervous System ◽  
Serotonin Syndrome ◽  
Neuromuscular System ◽  
Autonomic Nervous ◽  
Life Threatening ◽  
The Central Nervous System ◽  
Serotonin Toxicity

Serotonin syndrome affects the central nervous system, the autonomic nervous system, and the neuromuscular system and can have acute and potentially life-threatening manifestations. By definition, serotonin syndrome is associated with changes in serotonin exposure and thus might be described more accurately as serotonergic excess or serotonin toxicity. The central nervous system effects of serotonin involve regulation of attention, arousal, mood, learning, appetite, and temperature.

Serotonin Syndrome

2016 ◽  
Author(s):  
Ravi Mirpuri ◽  
Danielle Perret Karimi
Keyword(s):  
Cardiac Arrhythmias ◽  
Serotonin Syndrome ◽  
Complex Disease ◽  
Altered Mental Status ◽  
Detailed Understanding ◽  
Neuromuscular Abnormalities ◽  
Life Threatening ◽  
The Central Nervous System ◽  
Autonomic Hyperactivity

Serotonin syndrome (SS) is a complication that occurs due to drug interactions that result in an increase in serotonin in the central nervous system. This syndrome is classically described as a triad of altered mental status, autonomic hyperactivity, and neuromuscular abnormalities that can be life threatening. As such, prompt detection is crucial so that treatment can be delivered to prevent long-term complications from hyperthermia, malignant hypertension, and/or cardiac arrhythmias. Determining the diagnosis can be difficult as several other conditions have similarities to SS; these include malignant hyperthermia, neuroleptic malignant syndrome, and anticholinergic toxicity. If appropriately managed, SS typically resolves within 24 hours once all serotoninergic medications are discontinued. If inappropriately prescribed, serotoninergic drugs such as antibiotics, analgesics, supplements, or antidepressants may all contribute toward inducing this preventable syndrome, if given in excess. This comprehensive review of SS provides the clinician with a detailed understanding of the pathogenesis, diagnosis, and treatment of this complex disease state

scholarly journals Serotonin Syndrome: Pathophysiology, Clinical Features, Management, and Potential Future Directions

2019 ◽  
Vol 12 ◽  
pp. 117864691987392 ◽  
Author(s):  
William J Scotton ◽  
Lisa J Hill ◽  
Adrian C Williams ◽  
Nicholas M Barnes
Keyword(s):  
Serotonin Syndrome ◽  
Tryptophan Hydroxylase ◽  
Monoamine Oxidase Inhibitor ◽  
Receptor Activation ◽  
Clinical Findings ◽  
Oxidase Inhibitor ◽  
Health Concern ◽  
Drug Induced ◽  
Life Threatening ◽  
Serotonergic Drugs

Serotonin syndrome (SS) (also referred to as serotonin toxicity) is a potentially life-threatening drug-induced toxidrome associated with increased serotonergic activity in both the peripheral (PNS) and central nervous systems (CNS). It is characterised by a dose-relevant spectrum of clinical findings related to the level of free serotonin (5-hydroxytryptamine [5-HT]), or 5-HT receptor activation (predominantly the 5-HT1A and 5-HT2A subtypes), which include neuromuscular abnormalities, autonomic hyperactivity, and mental state changes. Severe SS is only usually precipitated by the simultaneous initiation of 2 or more serotonergic drugs, but the syndrome can also occur after the initiation of a single serotonergic drug in a susceptible individual, the addition of a second or third agent to long-standing doses of a maintenance serotonergic drug, or after an overdose. The combination of a monoamine oxidase inhibitor (MAOI), in particular MAO-A inhibitors that preferentially inhibit the metabolism of 5-HT, with serotonergic drugs is especially dangerous, and may lead to the most severe form of the syndrome, and occasionally death. This review describes our current understanding of the pathophysiology, clinical presentation and management of SS, and summarises some of the drugs and interactions that may precipitate the condition. We also discuss the newer novel psychoactive substances (NPSs), a growing public health concern due to their increased availability and use, and their potential risk to evoke the syndrome. Finally, we discuss whether the inhibition of tryptophan hydroxylase (TPH), in particular the neuronal isoform (TPH2), may provide an opportunity to pharmacologically target central 5-HT synthesis, and so develop new treatments for severe, life-threatening SS.

scholarly journals Serotonin Toxicity: Implications for Clinical Practice

2016 ◽  
Vol 13 (3) ◽  
Author(s):  
Auston Rotheram ◽  
Wayne Harris ◽  
Colin Curtain ◽  
David Nihill
Keyword(s):  
Adverse Reaction ◽  
Prescription Drugs ◽  
Serotonin Syndrome ◽  
Management Strategies ◽  
Clinical Information ◽  
Over The Counter ◽  
Life Threatening ◽  
Serotonergic Drugs ◽  
High Index Of Suspicion ◽  
Serotonin Toxicity

Serotonin toxicity, or serotonin syndrome, is a potentially life threatening adverse reaction to the use of one or more serotonergic drugs. Patients presenting with low level obscure symptoms may have pathophysiology rooted in adverse dopamine and serotonergic poly-pharmacy reactions involving illegal, over-the-counter and/or prescription drugs. In this clinical information paper an overview of serotonin toxicity, diagnostic criteria, and management strategies will be offered. Cultivating a high index of suspicion for serotonin toxicity across a broad patient demographic is recommended

scholarly journals Individual variability in clinical effect and tolerability of opioid analgesics – Importance of drug interactions and pharmacogenetics

2017 ◽  
Vol 17 (1) ◽  
pp. 193-200 ◽  
Author(s):  
Vigdis Solhaug ◽  
Espen Molden
Keyword(s):  
Side Effects ◽  
Drug Interactions ◽  
Clinical Effect ◽  
Pain Treatment ◽  
Opioid Analgesics ◽  
Individual Variability ◽  
Comorbid Condition ◽  
Variable Response ◽  
Increased Risk ◽  
Serotonergic Drugs

AbstractBackgroundAs pain is often a comorbid condition, many patients use opioid analgesics in combination with several other drugs. This implies a generally increased risk of drug interactions, which along with inherent pharmacogenetic variability and other factors may cause differences in therapeutic response of opioids.AimTo provide an overview of interactions and pharmacogenetic variability of relevance for individual differences in effect and tolerability of opioid analgesics, which physicians and other healthcare professionals should be aware of in clinical practice.MethodsThe article was based on unsystematic searches in PubMed to identify literature highlighting the clinical impact of drug interactions and pharmacogenetics as sources of variable response of opioid analgesics.ResultsCytochrome P450 (CYP)-mediated metabolism is an important process for both clinically relevant interactions and pharmacogenetic variability of several opioids. Concomitant use of CYP inhibitors (e.g. paroxetine, fluoxetine and bupropion) or inducers (e.g. carbamazepine, phenobarbital and phenytoin) could counteract the clinical effect or trigger side effects of analgesics in the same manner as genetically determined differences in CYP2D6-mediated metabolism of many opioids. Moreover, combination treatment with drugs that inhibit or induce P-glycoprotein (ABCB1), a blood-brain barrier efflux transporter, may alter the amount (‘dose’) of opioids distributed to the brain. At the pharmacodynamic level, it is crucial to be aware of the potential risk of interaction causing serotonergic syndrome when combining opioids and serotonergic drugs, in particular antidepressants inhibiting serotonin reuptake (SSRIs and SNRIs). Regarding pharmacogenetics at the receptor level of pain treatment, the knowledge is currently scarce, but an allelic variant of the μ1 opioid receptor (OPRM1) gene has been associated with higher dosage requirement to achieve analgesia.Conclusions and implicationsDrug interactions and pharmacogenetic differences may lead to therapeutic failure or serious side effects of opioid analgesics. Many interactions involve combinations with antidepressants and antiepileptics, which are highly relevant drugs in patients suffering from pain. To prevent unfavourable drug interactions it is important that clinicians pay close attention and use electronic drug interaction checkers when treatments are initiated or discontinued. For the management of issues related to pharmacogenetic differences, blood-based CYP genotyping is available as routine test at many laboratories, and provide a valuable tool for proper choice of drugs and doses for treatment of pain and other diseases.

Postoperative Serotonin Syndrome Following Methylene Blue Administration for Vasoplegia After Cardiac Surgery: A Case Report and Review of the Literature

2020 ◽  
pp. 108925322096025
Author(s):  
Mafdy N. Basta
Keyword(s):  
Methylene Blue ◽  
Case Report ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Serotonin Syndrome ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Medical Emergency ◽  
Serotonergic Activity ◽  
Threatening Condition ◽  
Life Threatening

Serotonin syndrome is a potentially life-threatening condition associated with increased serotonergic activity in the central nervous system. The increasing incidence of this condition is thought to parallel the increasing use of serotonergic agents in medical practice. The selective serotonin reuptake inhibitors are perhaps the most commonly implicated group of medications associated with serotonin syndrome. This case report describes the occurrence of postoperative serotonin syndrome in a patient on long-term sertraline who underwent coronary artery bypass graft and was treated with methylene blue for perioperative vasoplegia. It delineates the various clinical features commonly encountered and illustrates the recommended management modalities, including prevention, for this potentially lethal medical emergency. With prompt diagnosis and expeditious treatment, the patient has had full recovery.

scholarly journals Clinical Relevance of Pharmacogenetics in Serotonin Syndrome

2020 ◽  
Vol 2020 ◽  
pp. 1-7 ◽  
Author(s):  
Dehuti Pandya ◽  
My Tran ◽  
Monica Verduzco-Gutierrez
Keyword(s):  
Serotonin Syndrome ◽  
Low Dose ◽  
Genetic Profile ◽  
Threatening Condition ◽  
Life Threatening ◽  
Additive Risk ◽  
Serotonergic Drugs ◽  
Higher Doses ◽  
Dose Change ◽  
Stimulation Of

Serotonin syndrome is a predictable life-threatening condition that is caused by serotonergic stimulation of the central and peripheral nervous systems. A patient’s genetic profile can amplify exposure risk as many serotonergic drugs are metabolized by CYP450 enzymes, and these enzymes may be altered in functionality. We report a case of an elderly man who presented with serotonin syndrome after a dose change in valproic acid 5 weeks prior. His medication list consisted of low-dose serotonergic agents, which is unusual as most cases of serotonin syndrome involve higher doses. A review of his pharmacogenetic profile is presented to retrospectively evaluate the additive risk for serotonin syndrome and implications on resuming serotonergic agents.

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