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Título

Case report: Serotonin syndrome associated with medications with a secondary serotonergic effect

RESUMO

Case report:
A 31-year-old male patient with a diagnosis of obsessive compulsive disorder, undergoing knee pain investigation for two months, was referred to the emergency room due to myalgia and tremors of the extremities. He was on daily use of fluvoxamine 100mg, quetiapine 100mg and clomipramine 112.5mg increased for 3 weeks in addition to pregabalin and tramadol on demand. During evaluation, tachycardia, hyperthermia, diaphoresis, global hypertonicity and hyperreflexia were also present. Anxiety and restlessness quickly progressed to lethargy. Laboratory tests showed an increase in serum levels of creatine phosphokinase (CPK), characterizing rhabdomyolysis. Computed tomography of brain and cerebrospinal fluid examination showed no changes. Treatment involved discontinuation of offending agents, supportive therapy and use of benzodiazepine, in addition to monitoring for declining CPK levels.
Discussion:
Patients with serotonin syndrome can deteriorate rapidly and require intensive care. This syndrome occurs due to a progression of serotonergic toxicity based on an increase in its concentration levels. Conditions that can alter serotonin regulation include therapeutic doses, drug interactions, intentional or unintentional overdoses, and overlapping transitions between medications. Therefore, it can be avoided with careful titration of drugs and also observing the possibility of interaction with drug classes that do not indicate their serotonergic action in their nomenclature (e. g. opioids or antiepileptic drugs), especially in polypharmacy.
Final comments:
Serotonin syndrome is characterized by a triad of autonomic dysfunction, neuromuscular excitation and altered mental status caused by high levels of this neurotransmitter in the central and peripheral nervous systems. With the substantial increase in the use of antidepressants worldwide, serotonin syndrome has become common in recent decades. Due to its severity and high correlation with elevated levels of the serotonin, it can and should be avoided.

Palavras Chave

serotonin; syndrome; case report; polypharmacy.

Área

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