Posted by sam123 on September 2, 2007, at 12:19:02
In reply to Anyone speak French? Please interpret Dr.'s email, posted by Dragon Black on August 29, 2007, at 9:35:24
It is related to the TCA's, for which MAOI's are contraindicated:
Complications
In most reports, serotonin syndrome has been mild to moderate in severity without medical complications. However, a distinct minority of cases, particularly those associated with MAOI-tricyclic and MAOI-SRI combinations and MDMA, were severe and some fatal. Overall, medical complications appear to be less common than in NMS. Rhabdomyolysis was the most common serious medical complication of serotonin syndrome, occurring in 45 (26.8%) cases. Myoglobinuria and renal failure were reported in 8 (4.8%) patients. Generalized seizures were reported in 18 (10.7%) cases, including 7 fatalities. Similarly, DIC occurred in 8 patients, 5 of whom died. Thus, although medical complications were not common in patients with serotonin syndrome, they were associated with a substantial mortality risk.
ONSET AND PREDISPOSING FACTORS
Serotoninergic Medications
Nearly all medications that enhance CNS serotoninergic neurotransmission have been reported in association with cases of the serotonin syndrome (Table 3-1). Since the cases reviewed by Sternbach (1991), the most commonly implicated agents reported in subsequent case reports and case series have been combinations of MAOIs (reversible and irreversible) and tricyclics (N=18) and MAOIs and SRIs (N=34). These combinations also have been involved in 11 (61.1%) of the 18 fatal cases of serotonin syndrome. Serotonin syndrome has been reported when an MAOI was used in combination with L-tryptophan, dextromethorphan, or clonazepam. Tricyclics combined with alprazolam, amoxapine, SRIs, lithium, SRIs and lithium, trazodone and lithium, nefazodone and thioridazine, and m-chlorophenylpiperazine (m-CPP) also have been associated with the syndrome. SSRIs in combination with lithium, venlafaxine, buspirone, dextromethorphan, carbamazepine, clonazepam, mirtazapine, m-CPP, nefazodone, trazodone, risperidone, sumatriptan, dihydroergotamine and tramadol have been reported to produce serotonin syndrome. Combinations of nefazodone with trazodone, fluoxetine, valproate, and dothiepin have been reported.
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thread:779503
URL: http://www.dr-bob.org/babble/20070831/msgs/780362.html