Fast Five Quiz: Serotonin Syndrome

When serotonin toxicity is suspected, the most important initial step is to remove the offending agent. The best-known serotoninergic agents are antidepressants, as follows:

• Monoamine oxidase (MAO) inhibitors, such as MAO-A inhibitors (isocarboxazid, phenelzine, tranylcypromine) or MAO-B inhibitors (rasagiline, safinamide, selegiline)

• Tricyclic antidepressants, such as amitriptyline, amoxapine, clomipramine, cyclobenzaprine, desipramine, doxepin, imipramine, nortriptyline, protriptyline, and trimipramine

• SSRIs, such as citalopram, escitalopram, fluoxetine, paroxetine, fluvoxamine, sertraline, and vortioxetine

• Serotonin-norepinephrine reuptake inhibitors, such as desvenlafaxine, duloxetine, levomilnacipran, milnacipran, venlafaxine

• Bupropion

Many other pharmaceuticals are potential offending agents, including:

• Opioids, such as fentanyl, meperidine, oxycodone, hydrocodone, and tramadol

• 5-hydroxytryptamine (5-HT) (ie, serotonin) antagonists, such as ondansetron, granisetron, dolasetron, and palonosetron

• Triptans, such as sumatriptan, eletriptan, frovatriptan, and rizatriptan

• Stimulants, such as amphetamine, dexmethylphenidate, dextroamphetamine, diethylpropion, lisdexamfetamine, and methylphenidate

• Metoclopramide

• Trazodone

• Mirtazapine

• Methylene blue

• Linezolid

Antipsychotics (eg, olanzapine, risperidone, and quetiapine) and antibiotics (eg, linezolid) are also often implicated. In addition, recreational drugs (eg, 3,4-methylenedioxy-methamphetamine [MDMA; ecstasy], bath salts) and over-the-counter drugs (eg, St John's wort) have been associated with serotonin syndrome. Patients taking high doses of a serotoninergic drug are particularly vulnerable.

Read more about drugs involved with serotonin syndrome.

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Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.

Cite this: Richard H. Sinert. Fast Five Quiz: Serotonin Syndrome - Medscape - Jun 04, 2021.