Posted by SLS on November 8, 2000, at 20:32:08
In reply to Serzone and Aching Muscles-PLEASE HELP, posted by shellie on November 8, 2000, at 13:55:24
Shellie,
MAOI + serotonin reuptake inhibitor = Serotonin Syndrome
Serzone is a serotonin reuptake inhibitor, even though it is much less potent than the SSRIs. Perhaps it is more potent than its sister drug, trazodone, which is often chosen as a sleep-aid for insomnia associated with Parnate. I don't remember trazodone specifically being used by anyone with Nardil, but I imagine it is. I get the feeling that Nardil may be more potent than Parnate as an inhibitor of the MAO-A enzyme, which is responsible for breaking-down serotonin.
Muscle rigidity and hypertonia?
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http://www.vnh.org/EmergPsychHB/MedEmergSerotonin.html
The serotonin syndrome is a potentially dangerous adverse reaction which can occur during administration of serotonergic agents. It is attributed to a toxic hyperserotonergic state which is believed to result in hyperstimulation of the brain stem and spinal chord 5HT1A and 5HT2 receptors.
The syndrome has been documented in the medical literature since the 1960s. However, it appears that this adverse drug reaction may not be well recognised or be confused with other adverse events such as neuroleptic malignant syndrome or the hypertensive crisis manifested in the MAOI/tyramine reaction. In addition, manifestations of the syndrome may vary from mild changes in mental status, motor system changes and autonomic instability to potentially fatal reactions including rhabdomolysis and disseminated intravascular coagulopathy.1 Consequently the true incidence of the serotonin syndrome is not known.
In view of the popularity of the SSRIs clinicians should be aware of the signs and symptoms (see Table 1) and potential for occurrence of the serotonin syndrome.After evaluating the available literature Sternbach 2 and more recently Keltner 3 proposed that the following criteria be met for its diagnosis.
A. Symptoms must coincide with the initiation or increase in dose of a serotonergic agent.B. At lease THREE of the signs or symptoms attributed to the Serotonin Syndrome must be present :-
C. Other aetiologies such as metabolic disorders, infection, substance abuse or withdrawal must be excluded.
Table 1: Signs and Symptoms of the Serotonin Syndrome 1-3
Mental status/behavioural changes Altered muscle tone Autonomic instabilityAgitation
Myoclonus
Hypertension
Restlessness
Tremor
Hypotension
Confusion
Shivering Tachycardia
Incoordination
Rigidity
Sweating
Hypomania
Hyperreflexia
Fever
Possible seizures
Diarrhoea
ComaThe serotonin syndrome is most commonly reported with concomitant use of a MAOI (which blocks the metabolism of serotonin among other amines ) and either an SSRI (which blocks the reuptake of serotonin) or tryptophan , a serotonin precursor. 2 However, the combination of MAOIs with other serotonergic agents such as tricyclic antidepressants (clomipramine or amitriptyline ), pethidine, lithium and fenfluramine have been implicated. Both nonselective MAOIs and the newer selective MAOIs ( moclobemide and selegeline) have been associated with the serotonin syndrome. 3-4.
in the lower limbs.Autonomic and other clinical features include fever, sweating, nausea, vomiting, diarrhoea and hypertension.
Life-threatening acute complications include coma, seizures, rhabdomyolysis and disseminated intravascular coagulation (DIC).
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http://www.intox.org/pagesource/treatment/serotoninsyndrome.htm
CLINICAL FEATURESOnset of clinical features may be from hours to days after exposure to the causative agent(s). The classic triad of clinical features includes mental status, motor and autonomic changes. The combination of features observed is extremely variable between individual cases.
Mental status changes reported include anxiety, agitation, confusion, restlessness, hypomania, hallucinations and coma.
Motor changes include tremor, myoclonus, hypertonia, hyperreflexia and incoordination. Increased muscle tone is often most prominentThe Serotonin Syndrome
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poster:SLS
thread:48444
URL: http://www.dr-bob.org/babble/20001102/msgs/48472.html