Multiple drug interactions – induced serotonin syndrome: a case report

• Published in: Journal of clinical pharmacy and therapeutics Vol. 34; no. 4; pp. 485 - 487
• Main Authors: Montané, E., Barriocanal, A., Isern, I., Parajon, T., Costa, J.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.08.2009; Blackwell
• Subjects: Aged; Anti-Infective Agents - adverse effects; Anti-Infective Agents - pharmacology; Antidepressive Agents - adverse effects; Antidepressive Agents - pharmacology; Biological and medical sciences; ciprofloxacin; Ciprofloxacin - adverse effects; Ciprofloxacin - pharmacology; citalopram; drug interaction; Drug Interactions; fluoxetine; Humans; Male; Medical sciences; Pharmacology. Drug treatments; reboxetine; serotonin syndrome; Serotonin Syndrome - chemically induced; Serotonin Uptake Inhibitors - adverse effects; Serotonin Uptake Inhibitors - pharmacokinetics; Reboxetine; Serotonin; Fluoxetine; Psychotropic; Catecholamine; Reuptake inhibitor; Selective serotonin reuptake inhibitor; Citalopram; Case study; Fluoroquinolone derivatives; Serotonin syndrome; Neurotransmitter; Antidepressant agent; Norepinephrine; Drug interaction; Antibacterial agent; Ciprofloxacin; Quinolone derivatives
• ISSN: 0269-4727; 1365-2710
• DOI: 10.1111/j.1365-2710.2009.01023.x

Summary Serotonin syndrome is a potentially life‐threatening disorder of excessive serotoninergic activity often due to drug interactions. We report a case of serotonin syndrome induced by pharmacokinetic and pharmacodynamic interactions between three different selective serotonin‐reuptake inhibitors (SSRI) and possibly ciprofloxacin. Extreme caution is necessary in patients treated with serotonin‐reuptake inhibitors who need to be switched to another antidepressant or when they require the addition of concomitant drugs, especially serotoninergic drugs and isoenzimes of cytochrome P450 inhibitors.