Drug mention rates for NSAIDs, antidepressants,
and antihistamines at physician office visits,
1995 1996 1997 1998 1999 2000 2001 2002
Trends shown are significant (p<0.05).
NSAIDs are nonsteroidal anti-inflammatory drugs.
The purpose of this power point is:
– to provide a thorough review of the potentially
life-threatening complications that are
preventable by raising awareness.
Conclusion is clear, unlike the black box
warnings that the FDA requires regarding
suicidality within the first few weeks of
initiating SSRI therapy, serotonin toxicity
remains an elusive concept for even mental
Two or more of a combination of the following
drugs can increase the potential of developing
•SSRI & SNRIs
•Amphetamines (including MDMA-ecstasy)
•Opiate Analgesics (Demerol)
•OTC Cough Syrups
•Body building supplements containing L-Trytophan
(also found in turkey and aged cheeses)
•Herbal products such as St. John’s Wort and SAMI
Management of Serotonin Toxicity
•Discontinue causative agents.
•Benzodiazapines are first line therapy regardless of severity
to address agitation, hyperreflexia, muscle rigidity,
tremors and the underlying cause of hyperthermia.
• In more severe cases, cardiac, respiratory and thermal
abnormalities must be aggressively treated to reestablish
•It is worth noting that hyperthermic patients will not respond
to an antipyretic agent because the fever state is
associated with excessive muscle activity. In a severe
hyperthermic crisis immediate “paralysis is
recommended followed by intubation and ventilation.
•Atypical antipsychotic agents such as Zyprexa (olanzapine)
have also been used successfully for treating mild
symptoms of serotonin syndrome.
With heightened awareness by clinicians
regarding toxic symptoms and early recognition
as well as patient education on potential drug
interactions, serotonin syndrome can be
Take Home Message
Burt, C.W., (2004, July 14). Analyzing data on medications collected inAnalyzing data on medications collected in
the National Health Care Survey.the National Health Care Survey. U.S. DEPARTMENT OF HEALTH
AND HUMAN SERVICES, Centers for Disease Control and
Prevention, National Center for Health Statistics Retrieved March
24, 2008, from
Boyer E. & Shannon, M. (2005). Current concepts: The serotoninCurrent concepts: The serotonin
syndrome [Electronic version].syndrome [Electronic version]. New England Journal of Medicine,
Mackay, F.J., Dunn, N.R., & Mann, R.D. (1999). Antidepressants and theAntidepressants and the
serotonin syndrome in general practice [Electronic version].serotonin syndrome in general practice [Electronic version].
British Journal of General Practice, 49, 871-874.