Serotonin syndrome

Article Type
Changed
Wed, 07/26/2017 - 16:34
Display Headline
Serotonin syndrome

To the Editor: I enjoyed the article “Serotonin syndrome: Preventing, recognizing, and treating it.”1 I am a relatively new internal medicine physician, out of residency only 1 year, and sadly I felt that the psychiatric training I received was minimal at best. Therefore, I was very excited to read more about serotonin syndrome since such a large percentage of my patients are on selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors.

Could you speak to the time frame it takes for serotonin syndrome to develop? For instance, if someone is taking an SSRI and develops a terrible yeast infection, would 3 doses of fluconazole be enough to tip the scales? Or as-needed sumatriptan, with some ondansetron for migraine? The problem I have is that patients often require short doses of many medications that can interact, and I routinely sigh, briefly explain the possibility of serotonin syndrome, and then click through the flashing red warning signs on the electronic medical record and send patients out with their meds—though in honesty I do not know the likelihood of developing even mild symptoms of serotonin syndrome with short courses of interacting medications.

References
  1. Wang RZ, Vashistha V, Kaur S, Houchens NW. Serotonin syndrome: preventing, recognizing, and treating it. Cleve Clin J Med 2016; 83:810–817.
Article PDF
Author and Disclosure Information

Cielo Z. Rose, DO
Tallahassee Memorial Healthcare, Tallahassee, FL

Issue
Cleveland Clinic Journal of Medicine - 84(5)
Publications
Topics
Page Number
342-343
Legacy Keywords
serotonin syndrome, drug interactions, antidepressants, triptans, selective serotonin reuptake inhibitors, SSRIs, depression, yeast infection, fluconazole, Cielo Rose
Sections
Author and Disclosure Information

Cielo Z. Rose, DO
Tallahassee Memorial Healthcare, Tallahassee, FL

Author and Disclosure Information

Cielo Z. Rose, DO
Tallahassee Memorial Healthcare, Tallahassee, FL

Article PDF
Article PDF
Related Articles

To the Editor: I enjoyed the article “Serotonin syndrome: Preventing, recognizing, and treating it.”1 I am a relatively new internal medicine physician, out of residency only 1 year, and sadly I felt that the psychiatric training I received was minimal at best. Therefore, I was very excited to read more about serotonin syndrome since such a large percentage of my patients are on selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors.

Could you speak to the time frame it takes for serotonin syndrome to develop? For instance, if someone is taking an SSRI and develops a terrible yeast infection, would 3 doses of fluconazole be enough to tip the scales? Or as-needed sumatriptan, with some ondansetron for migraine? The problem I have is that patients often require short doses of many medications that can interact, and I routinely sigh, briefly explain the possibility of serotonin syndrome, and then click through the flashing red warning signs on the electronic medical record and send patients out with their meds—though in honesty I do not know the likelihood of developing even mild symptoms of serotonin syndrome with short courses of interacting medications.

To the Editor: I enjoyed the article “Serotonin syndrome: Preventing, recognizing, and treating it.”1 I am a relatively new internal medicine physician, out of residency only 1 year, and sadly I felt that the psychiatric training I received was minimal at best. Therefore, I was very excited to read more about serotonin syndrome since such a large percentage of my patients are on selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors.

Could you speak to the time frame it takes for serotonin syndrome to develop? For instance, if someone is taking an SSRI and develops a terrible yeast infection, would 3 doses of fluconazole be enough to tip the scales? Or as-needed sumatriptan, with some ondansetron for migraine? The problem I have is that patients often require short doses of many medications that can interact, and I routinely sigh, briefly explain the possibility of serotonin syndrome, and then click through the flashing red warning signs on the electronic medical record and send patients out with their meds—though in honesty I do not know the likelihood of developing even mild symptoms of serotonin syndrome with short courses of interacting medications.

References
  1. Wang RZ, Vashistha V, Kaur S, Houchens NW. Serotonin syndrome: preventing, recognizing, and treating it. Cleve Clin J Med 2016; 83:810–817.
References
  1. Wang RZ, Vashistha V, Kaur S, Houchens NW. Serotonin syndrome: preventing, recognizing, and treating it. Cleve Clin J Med 2016; 83:810–817.
Issue
Cleveland Clinic Journal of Medicine - 84(5)
Issue
Cleveland Clinic Journal of Medicine - 84(5)
Page Number
342-343
Page Number
342-343
Publications
Publications
Topics
Article Type
Display Headline
Serotonin syndrome
Display Headline
Serotonin syndrome
Legacy Keywords
serotonin syndrome, drug interactions, antidepressants, triptans, selective serotonin reuptake inhibitors, SSRIs, depression, yeast infection, fluconazole, Cielo Rose
Legacy Keywords
serotonin syndrome, drug interactions, antidepressants, triptans, selective serotonin reuptake inhibitors, SSRIs, depression, yeast infection, fluconazole, Cielo Rose
Sections
Disallow All Ads
Content Gating
No Gating (article Unlocked/Free)
Alternative CME
Article PDF Media