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