Serotonin toxicity: a short review of the literature and two case reports involving citalopram

Neurol Sci. 2011 Jun;32(3):507-9. doi: 10.1007/s10072-011-0546-z. Epub 2011 Apr 14.

Abstract

The serotonin toxicity (ST) is a potentially life-threatening adverse drug reaction results from therapeutic drug use, intentional self-poisoning, or inadvertent interactions between drugs. ST can be caused by a single or a combination of drugs with serotonergic activity due to excessive serotonergic agonism on central nervous system and peripheral serotonergic receptors (monoamine oxidase inhibitors, tricyclic antidepressants, SSRIs, opiate analgesics, over-the-counter cough medicines, antibiotics, weight-reduction agents, antiemetics, antimigraine agents, drugs of abuse, H2-antagonist and herbal products). The serotonin toxicity is often described as a clinical triad of mental-status changes (agitation and excitement with confusion), autonomic hyperactivity (diaphoresis, fever, tachycardia, and tachypnea), neuromuscular abnormalities (tremor, clonus, myoclonus, and hyperreflexia) and, in the advanced stage, spasticity; not all of these findings are consistently present. In this article, we describe two cases of ST due to interaction between Citalopram and two CYP2D6 inhibitors: Cimetidine and Topiramate and their clinical resolution after treatment discontinuation.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Aged
  • Cimetidine / administration & dosage
  • Cimetidine / adverse effects
  • Citalopram / administration & dosage
  • Citalopram / adverse effects*
  • Cytochrome P-450 CYP2D6 / physiology
  • Cytochrome P-450 CYP2D6 Inhibitors
  • Female
  • Fructose / administration & dosage
  • Fructose / adverse effects
  • Fructose / analogs & derivatives
  • Humans
  • Male
  • Selective Serotonin Reuptake Inhibitors / administration & dosage
  • Selective Serotonin Reuptake Inhibitors / adverse effects*
  • Serotonin Syndrome / chemically induced*
  • Serotonin Syndrome / diagnosis*
  • Serotonin Syndrome / metabolism
  • Topiramate

Substances

  • Cytochrome P-450 CYP2D6 Inhibitors
  • Serotonin Uptake Inhibitors
  • Citalopram
  • Topiramate
  • Fructose
  • Cimetidine
  • Cytochrome P-450 CYP2D6