Serotonin poisoning is a potentially life-threatening adverse drug reaction. Serotonin is a chemical produced by your body and is needed for your nerve cells and brain to function. Nerve cells in your brain and spinal cord (central nervous system) produce serotonin that helps regulate your attention, behavior and body temperature. Other nerve cells in your body, primarily in your intestines, also produce serotonin. In these other areas, serotonin plays a role in regulating your digestive process, blood flow and breathing. But too much serotonin can cause problems.
Serotonin poisoning occurs when you take medications, illicit drugs and dietary supplements that cause high levels of the chemical serotonin to accumulate in your body. It can occur when you increase the dose of such a drug or add a new drug to the ones you take already.
Some experts strongly prefer the terms serotonin toxicity or serotonin toxidrome because these terms accurately reflect the fact that it is a form of poisoning. It may also be called serotonin syndrome, serotonin storm, hyperserotonemia or serotonergic syndrome.
Serotonin poisoning typically occurs within several hours of taking a new drug or increasing the dose of a drug you're already taking.
Serotonin poisoning symptoms range from shivering to diarrhea. Severe serotonin poisoning can be life-threatening. Signs and symptoms include high fever, seizures, irregular heartbeat and unconsciousness.
Severe serotonin poisoning can be fatal if it isn't treated. Serotonin poisoning usually goes away within a day of stopping the medications causing symptoms and taking drugs that block serotonin.
Additional symptoms and signs of serotonin poisoning include:
• Agitation or restlessness
• Confusion
• Rapid heart rate
• Dilated pupils
• Loss of muscle coordination or twitching muscles
• Heavy sweating
• Diarrhea
• Headache
• Shivering
• Goose bumps
If you suspect you might have serotonin poisoning after starting a new drug or increasing the dose of a drug you're already taking, call your doctor right away or go to the emergency room. If you have severe or rapidly worsening symptoms, seek emergency treatment immediately.
In some cases, serotonin poisoning can be caused by taking just one drug that increases serotonin levels, but it occurs most often when you combine certain medications. For example, serotonin syndrome may occur if you take an antidepressant along with a migraine medication. A common cause of serotonin syndrome is intentional overdose of antidepressant medications.
A large number of medications either alone or in combination can produce serotonin syndrome. A number of over-the-counter and prescription drugs can lead to serotonin syndrome, especially antidepressants. Illicit drugs and dietary supplements also can cause the condition. Examples of all of these include:
• Serotonin reuptake inhibitors (SSRIs), which include antidepressants such as Celexa, Prozac, Sarafem, fluvoxamine, Paxil and Zoloft
• Serotonin and norepinephrine reuptake inhibitors (SNRIs), which include antidepressants such as trazodone and Effexor
• Bupropion, an antidepressant and tobacco-addiction medication (Wellbutrin and Zyban)
• Monoamine oxidase inhibitors (MAOIs), including antidepressants such as Marplan and Nardil
• Anti-migraine medications such as Axert, Amerge, Imitrex and Zomig
• Pain medications such as Sublimaze, Demerol, Talwin, and Ultram
• Lithium (Eskalith, Lithobid)
• Illicit drugs, including LSD, ecstasy, cocaine and amphetamines
• Herbal supplements, including St. John's wort and ginseng
• Over-the-counter cough and cold medications (Robitussin DM, Sudal DM)
• Anti-nausea medications (Kytril, Reglan, Zofran)
• Linezolid (Zyvox)
• Ritonavir (Norvir)
Some people are more susceptible to the drugs and supplements that cause serotonin poisoning than are others, but the condition can occur in anyone. You're at increased risk of serotonin poisoning if you recently started taking or increased the dose of a new medication known to increase serotonin levels, you take more than one drug known to increase serotonin levels, you take herbal supplements known to increase serotonin levels, or you use an illicit drug known to increase serotonin levels.
Talk to your doctor about possible risks. Don't stop taking medications on your own. If your doctor prescribes a new medication, make sure he or she knows about all the other medications you're taking (especially if you receive prescriptions from more than one doctor).
Sources:
http://en.wikipedia.org
http://www.theledger.com
http://www.mayoclinic.com
http://www.healthcentral.com
MC Ortega is the former publicist for the late Walter Payton, Coca-Cola and Dunkin’ Donuts. Ortega is a senior communications and messaging executive specializing in media relations, social media, program development and crisis communications. Also, Ortega is an avid traveler and international shopper. Ortega resides with her partner, Craig, dog, Fionne and extensive shoe collection. Ortega also enjoys jewelry design/production and flamenco dancing.