Serotonin syndrome

Serotonin syndrome

overview

Serotonin syndrome is a serious drug reaction. It is caused by medications that build up high levels of serotonin in the body.

Serotonin is a chemical that the body produces naturally. It is needed for the nerve cells and brain to function. But too much serotonin causes signs and symptoms that can range from mild (chills and diarrhea) to severe (muscle stiffness, fever and seizures). Severe serotonin syndrome can lead to death if left untreated.

Serotonin syndrome can occur when you increase the dose of certain medications or start taking a new medication. It is most commonly caused by the combination of medications that contain serotonin such as: B. a migraine medication and an antidepressant. Some illegal drugs and supplements have been linked to serotonin syndrome.

Milder forms of serotonin syndrome may resolve within a day or two after stopping the medications that cause symptoms and sometimes after taking medications that block serotonin.

Symptoms

Symptoms of serotonin syndrome usually appear within a few hours of taking a new medication or increasing the dose of a medication you are already taking.

Signs and symptoms include:

• Unruhe oder Unruhe
• Schlaflosigkeit
• Verwirrtheit
• Schnelle Herzfrequenz und Bluthochdruck
• Erweiterte Pupillen
• Verlust der Muskelkoordination oder Muskelzuckungen
• Hoher Blutdruck
• Muskelsteifheit
• Starkes Schwitzen
• Durchfall
• Kopfschmerzen
• Zittern
• Gänsehaut

Severe serotonin syndrome can be life-threatening. Characters include:

• Hohes Fieber
• Tremor
• Krampfanfälle
• Herzrhythmusstörung
• Bewusstlosigkeit

When to go to the doctor?

If you think you may have serotonin syndrome after starting a new medication or increasing the dose of a medication you are already taking, call your doctor or go to the emergency room immediately. If you have severe or rapidly worsening symptoms, seek emergency treatment immediately.

Causes

Excessive accumulation of serotonin in the body leads to the symptoms of serotonin syndrome.

Typically, nerve cells in the brain and spinal cord produce serotonin, which helps regulate attention, behavior and body temperature.

Other nerve cells in the body, especially in the intestines, also produce serotonin. Serotonin plays a role in regulating the digestive process, blood flow and breathing.

Although it is possible that taking just one drug that increases serotonin levels can cause serotonin syndrome in some people, this condition most often occurs when people combine certain medications.

For example, serotonin syndrome can occur if you take an antidepressant along with a migraine medication. It can also occur if you take an antidepressant with an opioid pain reliever.

Another cause of serotonin syndrome is intentional overdose of antidepressants.

A number of over-the-counter and prescription medications, particularly antidepressants, may be associated with serotonin syndrome. Illegal drugs and dietary supplements may also be linked to the condition.

Medications and supplements that could potentially cause serotonin syndrome include:

• Selektive Serotonin-Wiederaufnahmehemmer (SSRIs), Antidepressiva wie Citalopram (Celexa), Fluoxetin (Prozac), Fluvoxamin (Luvox), Escitalopram (Lexapro), Paroxetin (Paxil, Pexeva, Brisdelle) und Sertralin (Zoloft)
• Serotonin- und Noradrenalin-Wiederaufnahmehemmer (SNRIs), Antidepressiva wie Desvenlafaxin (Pristiq), Levomilnacipran (Fetzima), Milnacipran (Savella), Duloxetin (Cymbalta, Drizalma Sprinkle) und Venlafaxin (Effexor XR)
• Bupropion (Zyban, Wellbutrin SR, Wellbutrin XL), ein Medikament gegen Depressionen und Tabaksucht
• Trizyklische Antidepressiva, wie Amitriptylin und Nortriptylin (Pamelor)
• Monoaminoxidase-Hemmer (MAO-Hemmer), Antidepressiva wie Isocarboxazid (Marplan) und Phenelzin (Nardil)
• Medikamente gegen Migräne, wie Carbamazepin (Tegretol, Carbatrol, andere), Valproinsäure und Triptane, zu denen Almotriptan, Naratriptan (Amerge) und Sumatriptan (Imitrex, Tosymra, andere) gehören
• Schmerzmittel, wie Opioid-Schmerzmittel einschließlich Codein, Fentanyl (Duragesic, Abstral, andere), Hydrocodon (Hysingla ER), Meperidin (Demerol), Oxycodon (Oxycontin, Roxicodone, andere) und Tramadol (Ultram, ConZip)
• Lithium (Lithobid), ein Stimmungsstabilisator
• Illegale Drogen, einschließlich LSD, Ecstasy, Kokain und Amphetamine
• Kräuterzusätze, darunter Johanniskraut, Ginseng und Muskatnuss
• Rezeptfreie Husten- und Erkältungsmittel enthält Dextromethorphan (Delsym)
• Medikamente gegen Übelkeit wie Granisetron (Sancuso, Sustol), Metoclopramid (Reglan), Droperidol (Inapsine) und Ondansetron (Zofran)
• Linezolid (Zyvox), ein Antibiotikum
• Ritonavir (Norvir), ein antiretrovirales Medikament zur Behandlung von HIV

Risk factors

Some people are more likely to be affected by the medications and supplements that cause serotonin syndrome than others, but the condition can occur in anyone.

You are at increased risk of serotonin syndrome if:

• Sie haben kürzlich mit der Einnahme eines Medikaments begonnen oder dessen Dosis erhöht, von dem bekannt ist, dass es den Serotoninspiegel erhöht
• Sie nehmen mehr als ein Medikament ein, von dem bekannt ist, dass es den Serotoninspiegel erhöht
• Sie nehmen pflanzliche Nahrungsergänzungsmittel ein, von denen bekannt ist, dass sie den Serotoninspiegel erhöhen
• Sie verwenden eine illegale Droge, von der bekannt ist, dass sie den Serotoninspiegel erhöht

Complications

Serotonin syndrome generally does not cause problems once serotonin levels return to their original levels.

If left untreated, severe serotonin syndrome can lead to loss of consciousness and death.

prevention

Taking more than one serotonin-related drug or increasing your dose of a serotonin-related drug increases your risk of serotonin syndrome. Find out what medications you are taking and give your doctor or pharmacist a complete list of your medications.

Be sure to talk to your doctor if you or a family member has experienced symptoms after taking any medication.

Also talk to your doctor about possible risks. Do not stop taking medication on your own. If your doctor prescribes a new medication, make sure he or she knows about any other medications you are taking, especially if you get prescriptions from more than one doctor.

If you and your doctor decide that the benefits of combining certain medications that affect serotonin levels outweigh the risks, be aware of the possibility of serotonin syndrome.

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