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Patient education: Serotonin syndrome (The Basics)

Patient education: Serotonin syndrome (The Basics)

What is serotonin syndrome? — Serotonin syndrome is a problem that can happen after taking certain medicines. It is uncommon but can be serious or even deadly if it does happen.

Serotonin syndrome causes symptoms such as:

Feeling anxious, restless, or confused

Sweating

Muscle spasms or muscles that cannot relax normally

Very fast back-and-forth eye movements

Shaking or trembling

Fever

A fast heartbeat

Vomiting

Diarrhea

What causes serotonin syndrome? — Serotonin syndrome can happen to people after they take certain medicines or combinations of medicines. It can also happen with certain herbal products and street drugs. There are many medicines and drugs that can lead to serotonin syndrome. In general, they increase a chemical in the brain and body called "serotonin." Serotonin syndrome happens when the levels of serotonin in your brain get too high.

Examples of the medicines and drugs that can cause serotonin syndrome include:

Some medicines used to treat depression, such as selective serotonin reuptake inhibitors ("SSRIs")

Some medicines used to treat Parkinson disease, such as selegiline (sample brand names: Eldepryl, Emsam) and rasagiline (brand name: Azilect)

Some pain relievers, such as meperidine (sample brand name: Demerol), tramadol (sample brand name: Ultram), fentanyl, and cyclobenzaprine (sample brand name: Flexeril)

Saint John's wort (an herbal medicine sometimes used for depression)

Medicines used to treat migraine headaches, called "triptans"

Some medicines used to treat attention deficit hyperactivity disorder (ADHD)

An antibiotic called linezolid (brand name: Zyvox)

A cough medicine called dextromethorphan (sample brand names: Delsym, Robitussin DM)

Street drugs, such as ecstasy, cocaine, and amphetamines

Doctors do not know why some people get serotonin syndrome and others do not. But they do know that people usually get it within hours of taking a new medicine or drug, a higher dose, or a new combination of medicines or drugs.

Should I see a doctor or nurse? — Yes. If you have symptoms of serotonin syndrome, and especially if you recently took a new drug or medicine or a new dose, call your doctor right away. Without proper treatment, severe serotonin syndrome can be deadly.

Can serotonin syndrome be serious? — Yes. Severe symptoms include seizures, high fever, sudden changes in blood pressure or heart rate, and passing out. If you or someone you know has severe symptoms, go to the emergency room or call for an ambulance (in the US and Canada, dial 9-1-1).

Will I need tests? — Maybe. There is no one test that can show whether or not you have serotonin syndrome. Still, some of the things the doctor will do during the exam can help him or her figure out if you have it. For instance, the doctor might test your leg muscles to see if they spasm. The doctor will also ask questions about any medicines, herbal products, or street drugs you might have taken.

If you have serotonin syndrome, it's very important to be honest with your doctor about what you took, how much, and when. This way they will know how to properly treat you.

How is serotonin syndrome treated? — As part of treatment, the doctor will stop the medicines or drugs that caused the serotonin syndrome in the first place. They will also monitor your breathing, heart rate, blood pressure, and body temperature, and try to keep these as close to normal as possible.

Depending on what you need, they might also:

Give you medicines to calm you

Give you medicines to block the effects of serotonin

Work with you to decide whether you should keep taking the medicines that caused your serotonin syndrome

Can serotonin syndrome be prevented? — Not always. But there are things you can do to lower the risk.

Doctors have no way to predict who will get serotonin syndrome, so it's not possible to prevent cases caused by properly prescribed medicines. Even so, there are things you can do to protect yourself from dangerous reactions to medicines:

Always tell any doctor who prescribes medicines for you about all the medicines, herbal products, and street drugs you take. That way, the doctor can be careful not to give you medicines that could cause problems when combined.

If you are already taking any medicines, check with your doctor, nurse, or pharmacist before taking anything else. This includes over-the-counter medicines, supplements, or herbs.

When starting a new medicine, have the pharmacist check for drug interactions.

Have your doctor, nurse, or pharmacist regularly review your medications list with you to be sure it's correct. They can also make sure you are taking the correct amounts and not taking any medicine you were supposed to stop.

More on this topic

Patient education: Medicines for depression (The Basics)
Patient education: Depression (The Basics)

Patient education: Depression in adults (Beyond the Basics)
Patient education: Depression treatment options for adults (Beyond the Basics)

This topic retrieved from UpToDate on: Jan 02, 2023.
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