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Dextromethorphan-induced serotonin syndrome.

Anna R Schwartz¹, Anthony F Pizon, Daniel E Brooks

¹University of Pittsburgh, Division of Medical Toxicology, UPMC Presbyterian, Pittsburgh, Pennsylvania 15213, USA.

Clinical Toxicology (Philadelphia, Pa.)

|February 25, 2009

Summary

This summary is machine-generated.

Supra-therapeutic doses of dextromethorphan combined with selective serotonin reuptake inhibitors (SSRIs) can cause serotonin syndrome. These cases confirm dextromethorphan-induced serotonin syndrome using serum drug levels.

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Area of Science:

Clinical Toxicology
Pharmacology
Neuroscience

Background:

Dextromethorphan potentiates serotonin, potentially causing serotonin syndrome.
Published cases of dextromethorphan-induced serotonin syndrome are rare, suggesting therapeutic doses may not be sufficient.
This study investigates serotonin syndrome in the context of dextromethorphan and SSRI co-administration.

Observation:

Two cases of serotonin syndrome are presented.
Patients exhibited supra-therapeutic dextromethorphan levels alongside therapeutic SSRI levels.
Serum drug levels confirmed elevated dextromethorphan concentrations (950 ng/mL and 2820 ng/mL).

Findings:

These are the first reported cases confirming dextromethorphan-induced serotonin syndrome using serum dextromethorphan and SSRI levels.
Findings suggest that supra-therapeutic dextromethorphan doses are necessary for serotonin syndrome development when co-administered with therapeutic SSRI doses.
Further research is needed to fully elucidate the relationship between dextromethorphan dosage and serotonin syndrome risk.

Implications:

Highlights the potential risk of serotonin syndrome with high-dose dextromethorphan, especially when combined with SSRIs.
Emphasizes the importance of monitoring drug levels in suspected cases of drug-induced toxicity.
Informs clinical practice regarding the safe use of dextromethorphan in patients taking SSRIs.