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Serotonin syndrome with elevated paroxetine concentrations.

Larissa I Velez1, Greene Shepherd, Brett A Roth

  • 1University of Texas South-western Medical Center, Dallas, TX 75390-8579, USA. larissa.velez@utsouthwestern.edu

The Annals of Pharmacotherapy
|January 27, 2004
PubMed
Summary

This case study details a severe serotonin syndrome reaction in a patient who overdosed on paroxetine and consumed alcohol. High paroxetine levels were observed, and cyproheptadine treatment showed limited benefit.

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Area of Science:

  • Pharmacology
  • Toxicology
  • Clinical Medicine

Background:

  • Serotonin syndrome is a potentially life-threatening condition.
  • It is typically associated with serotonergic medications, but co-ingestion with other substances can alter presentation.
  • Paroxetine is a selective serotonin reuptake inhibitor (SSRI) commonly prescribed for depression and anxiety disorders.

Observation:

  • A 57-year-old male presented with symptoms of serotonin syndrome after ingesting a large dose of paroxetine (3600 mg) and ethanol.
  • Physical examination revealed dilated pupils, flushing, diaphoresis, myoclonic jerks, tremors, and hyperreflexia.
  • Serum paroxetine concentrations were significantly elevated, reaching 1800 ng/mL, far exceeding the normal therapeutic range.

Findings:

  • The patient's symptoms gradually resolved over six days.

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  • Cyproheptadine, a suggested treatment, showed no observable benefit in this case.
  • The Naranjo probability scale indicated a probable link between the patient's condition and the paroxetine overdose.

    • Implications:

    • This case underscores the risk of severe serotonin syndrome even with a single serotonergic medication in overdose.
    • Further research is needed to clarify the efficacy of cyproheptadine and other serotonin antagonists in managing serotonin syndrome.
    • Management should focus on supportive care, including fluid balance, decontamination, and controlling hyperthermia, agitation, and seizures.