Pharmacogenetic workup of perioperative serotonin syndrome

J Clin Anesth. 2013 Dec;25(8):662-5. doi: 10.1016/j.jclinane.2013.06.005. Epub 2013 Oct 1.

Abstract

Serotonin syndrome is gaining attention in perioperative and chronic pain settings due to the growing prevalence of multimodal therapies that increase serotonin levels and thereby heighten patient risk. A patient's genetic make-up may further increase the risk of serotonin syndrome. A case of serotonin syndrome on emergence after general anesthesia is presented. A subsequent cytochrome P4502D6 genetic test result suggested a potential alteration in metabolism. For this patient, who was taking combination antidepressant medications and receiving common perioperative medicines, additive pharmacodynamic effects converged with a pharmacogenetic predisposition, resulting in serotonin syndrome.

Keywords: Duloxetine; Multimodal therapy; P4502D6 chromosome; Perioperative serotonin syndrome; Pharmacogenetics.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anesthesia, General / adverse effects
  • Cytochrome P-450 CYP2D6 / genetics
  • Drug Interactions
  • Duloxetine Hydrochloride
  • Genetic Predisposition to Disease
  • Humans
  • Male
  • Middle Aged
  • Postoperative Complications / diagnosis
  • Postoperative Complications / genetics*
  • Selective Serotonin Reuptake Inhibitors / adverse effects
  • Serotonin Syndrome / diagnosis
  • Serotonin Syndrome / etiology
  • Serotonin Syndrome / genetics*
  • Thiophenes / adverse effects

Substances

  • Serotonin Uptake Inhibitors
  • Thiophenes
  • Duloxetine Hydrochloride
  • Cytochrome P-450 CYP2D6