Serotonin syndrome

hyperserotonemiaserotonin toxicitycentral toxic serotonin reactioncentrally-toxic serotonin syndrome
Serotonin syndrome (SS) is a group of symptoms that may occur with the use of certain serotonergic medications or drugs.wikipedia
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Tramadol

UltramUltracetUltram ER
This may include selective serotonin reuptake inhibitor (SSRI), serotonin norepinephrine reuptake inhibitor (SNRI), monoamine oxidase inhibitor (MAOI), tricyclic antidepressants (TCAs), amphetamines, pethidine (meperidine), tramadol, dextromethorphan, buspirone, L-tryptophan, 5-HTP, St. John's wort, triptans, ecstasy (MDMA), metoclopramide, ondansetron, or cocaine.
Serious side effects may include seizures, increased risk of serotonin syndrome, decreased alertness, and drug addiction.

Buspirone

Busparbuspirone hydrochloride
This may include selective serotonin reuptake inhibitor (SSRI), serotonin norepinephrine reuptake inhibitor (SNRI), monoamine oxidase inhibitor (MAOI), tricyclic antidepressants (TCAs), amphetamines, pethidine (meperidine), tramadol, dextromethorphan, buspirone, L-tryptophan, 5-HTP, St. John's wort, triptans, ecstasy (MDMA), metoclopramide, ondansetron, or cocaine.
Serious side effects may include hallucinations, serotonin syndrome, and seizures.

Monoamine oxidase inhibitor

MAOImonoamine oxidase inhibitorsMAOIs
This may include selective serotonin reuptake inhibitor (SSRI), serotonin norepinephrine reuptake inhibitor (SNRI), monoamine oxidase inhibitor (MAOI), tricyclic antidepressants (TCAs), amphetamines, pethidine (meperidine), tramadol, dextromethorphan, buspirone, L-tryptophan, 5-HTP, St. John's wort, triptans, ecstasy (MDMA), metoclopramide, ondansetron, or cocaine.
Tryptophan supplements should not be consumed with MAOIs as the potentially fatal serotonin syndrome may result.

Hyperthermia

heat stresshyperthermicheat stroke
Symptoms include high body temperature, agitation, increased reflexes, tremor, sweating, dilated pupils, and diarrhea.

Pethidine

meperidineDemerolPethidine/meperidine
This may include selective serotonin reuptake inhibitor (SSRI), serotonin norepinephrine reuptake inhibitor (SNRI), monoamine oxidase inhibitor (MAOI), tricyclic antidepressants (TCAs), amphetamines, pethidine (meperidine), tramadol, dextromethorphan, buspirone, L-tryptophan, 5-HTP, St. John's wort, triptans, ecstasy (MDMA), metoclopramide, ondansetron, or cocaine.
The norpethidine metabolite was found to have serotonergic effects, so pethidine could, unlike most opioids, contribute to serotonin syndrome.

Rhabdomyolysis

muscle breakdownrapid muscle breakdownbreakdown of skeletal muscle
Body temperature can increase to greater than 41.1 C. Complications may include seizures and extensive muscle breakdown.

Myoclonus

myoclonicmyoclonic jerkmyoclonic jerks
Mild symptoms may consist of increased heart rate, shivering, sweating, dilated pupils, myoclonus (intermittent jerking or twitching), as well as overresponsive reflexes.
Most often, myoclonus is one of several signs in a wide variety of nervous system disorders such as multiple sclerosis, Parkinson's disease, dystonia, Alzheimer's disease, Gaucher's disease, subacute sclerosing panencephalitis, Creutzfeldt–Jakob disease (CJD), serotonin toxicity, some cases of Huntington's disease, some forms of epilepsy, and occasionally in intracranial hypotension.

Dextromethorphan

DXMVicks Formula 44Creo-Terpin
This may include selective serotonin reuptake inhibitor (SSRI), serotonin norepinephrine reuptake inhibitor (SNRI), monoamine oxidase inhibitor (MAOI), tricyclic antidepressants (TCAs), amphetamines, pethidine (meperidine), tramadol, dextromethorphan, buspirone, L-tryptophan, 5-HTP, St. John's wort, triptans, ecstasy (MDMA), metoclopramide, ondansetron, or cocaine.
Dextromethorphan should not be taken with monoamine oxidase inhibitors (MAOIs) due to the potential for serotonin syndrome, which is a potentially life-threatening condition that can occur rapidly, due to a buildup of an excessive amount of serotonin in the body.

Cyproheptadine

Periactin
If this is not sufficient, a serotonin antagonist such as cyproheptadine may be used.
Of the serotonin receptors, it is an especially potent antagonist of the 5-HT 2 receptors, and this underlies its effectiveness in the treatment of serotonin syndrome.

Amphetamine

Benzedrinespeedamphetamines
This may include selective serotonin reuptake inhibitor (SSRI), serotonin norepinephrine reuptake inhibitor (SNRI), monoamine oxidase inhibitor (MAOI), tricyclic antidepressants (TCAs), amphetamines, pethidine (meperidine), tramadol, dextromethorphan, buspirone, L-tryptophan, 5-HTP, St. John's wort, triptans, ecstasy (MDMA), metoclopramide, ondansetron, or cocaine.

Hyperreflexia

Hyperactive reflexesoverresponsive reflexesAbnormally fast reflexes
Symptoms include high body temperature, agitation, increased reflexes, tremor, sweating, dilated pupils, and diarrhea. Mild symptoms may consist of increased heart rate, shivering, sweating, dilated pupils, myoclonus (intermittent jerking or twitching), as well as overresponsive reflexes.
But hyperreflexia can be developed via many other causes, including medication and stimulant side effects, hyperthyroidism, electrolyte imbalance, serotonin syndrome, severe brain trauma, multiple sclerosis, Reye syndrome, and preeclampsia.

MDMA

ecstasyMethylenedioxymethamphetamineE
This may include selective serotonin reuptake inhibitor (SSRI), serotonin norepinephrine reuptake inhibitor (SNRI), monoamine oxidase inhibitor (MAOI), tricyclic antidepressants (TCAs), amphetamines, pethidine (meperidine), tramadol, dextromethorphan, buspirone, L-tryptophan, 5-HTP, St. John's wort, triptans, ecstasy (MDMA), metoclopramide, ondansetron, or cocaine. Tremor is a common side effect of MDMA's action on dopamine, whereas hyperreflexia is symptomatic of exposure to serotonin agonists.
Acute toxicity is mainly caused by serotonin syndrome and sympathomimetic effects.

Fentanyl

ActiqDuragesicfentanyl citrate
Serious side effects may include decreased breathing (respiratory depression), serotonin syndrome, low blood pressure, addiction, or coma.

Hydrocodone

TussionexHycodandihydrocodeinone
Serious side effects may include abuse, low blood pressure, seizures, QT prolongation, respiratory depression, and serotonin syndrome.

Serotonin

5-HTserotonergic5-hydroxytryptamine
It is a predictable consequence of excess serotonin on the central nervous system (CNS).
Extremely high levels of serotonin can cause a condition known as serotonin syndrome, with toxic and potentially fatal effects.

Antidepressant

antidepressantsanti-depressantanti-depressants
Almost any medication involved with serotonin regulation has the potential to cause serotonin toxicity (also known as serotonin syndrome) – an excess of serotonin that can induce mania, restlessness, agitation, emotional lability, insomnia and confusion as its primary symptoms.

Lisdexamfetamine

Vyvanselisdexamfetamine dimesylatelisdexamphetamine
Serotonin syndrome may occur if used with certain other medications.

Selective serotonin reuptake inhibitor

SSRIselective serotonin reuptake inhibitorsSSRIs
This may include selective serotonin reuptake inhibitor (SSRI), serotonin norepinephrine reuptake inhibitor (SNRI), monoamine oxidase inhibitor (MAOI), tricyclic antidepressants (TCAs), amphetamines, pethidine (meperidine), tramadol, dextromethorphan, buspirone, L-tryptophan, 5-HTP, St. John's wort, triptans, ecstasy (MDMA), metoclopramide, ondansetron, or cocaine.
Serotonin syndrome is a short-lived condition that can range from mild (most common) to deadly.

Trazodone

DesyrelOleptroTrialodine
There are reported cases of high doses of trazodone precipitating serotonin syndrome.

Linezolid

Zyvoxlinezoid
Serious side effects may include serotonin syndrome, bone marrow suppression, and high blood lactate levels, particularly when used for more than two weeks.

Clonus

clonicclonic seizuresclonic contractions
The overactive reflexes and clonus in moderate cases may be greater in the lower limbs than in the upper limbs.
Clonus has also appeared after ingesting potent serotonergic drugs, where ingestion strongly predicts imminent serotonin toxicity (serotonin syndrome).

Heat stroke

sunstrokeheatstrokeharmful heat
Other conditions that can produce similar symptoms such as neuroleptic malignant syndrome, malignant hyperthermia, anticholinergic toxicity, heat stroke, and meningitis should be ruled out.
Dantrolene, a direct-acting paralytic which abolishes shuddering and is effective in many other forms of hyperthermia, including centrally-, peripherally- and cellularly-mediated thermogenesis, has no individual or additive effects to cooling in the context of heat stroke, showing a lack of endogenous thermogenic response to cold water immersion.

Serotonin receptor agonist

serotonin agonistserotonin agonists5-HT1 agonist
Tremor is a common side effect of MDMA's action on dopamine, whereas hyperreflexia is symptomatic of exposure to serotonin agonists.
Selective 5-HT 2A receptor agonists like the 25-NB compounds can cause serotonin syndrome-like adverse effects such as hyperthermia, hyperpyrexia, tachycardia, hypertension, clonus, seizures, agitation, aggression, and hallucinations, most importantly in overdose.

Neuroleptic malignant syndrome

Malignant neuroleptic syndrome
Other conditions that can produce similar symptoms such as neuroleptic malignant syndrome, malignant hyperthermia, anticholinergic toxicity, heat stroke, and meningitis should be ruled out.
The differential diagnosis is similar to that of hyperthermia, and includes serotonin syndrome.

Tapentadol

Nucynta
Combination with SSRIs/SNRIs, SRAs, serotonin receptor agonists may lead to potentially lethal serotonin syndrome.