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Serotonin syndrome due to venlafaxine and maintenance tranylcypromine therapy

Department of Emergency Medicine, St Joseph Hospital, Bangor, Maine

Thomas G Martin

Toxicology Treatment Program, University of Pittsburgh Medical Center

Edward P Krenzelok

Pittsburgh Poison Center, Childrens Hospital of Pittsburgh. Toxicology Treatment Program, Rm NE-583, Montifore Univ. Hospital, University of Pittsburgh Medical Center, 200 Lothrop St, Pittsburgh, Pennsylvania 15213, USA

A number of novel serotonergic antidepressants have been introduced to clinical practice over the last decade. These medications are felt to be safe alternatives to the traditional tricyclic antidepressants and monoamine oxidase inhibitors, particularly in the overdose setting. Serious adverse reactions and drug interactions have been appreciated and fatalities have been reported. We describe the development of the serotonin syndrome in a 60 year old female on chronic tranylcypromine treatment following the inadvertent ingestion of a single dose of venlafaxine. Manifestations included an altered mental status that progressed to hyperthermia and coma. She recovered quickly and without complications. Health care providers and poison specialists need to be aware that this potentially serious syndrome can be precipitated by a single dose of a serotonin reuptake inhibitor in patients being treated with a monoamine oxidase inhibitor.

Key Words: venlafaxine • tranylcypromine • monoamine oxidase inhibitors • serotonin syndrome • hyperthermia

Human & Experimental Toxicology, Vol. 16, No. 1, 14-17 (1997)
DOI: 10.1177/0960327197016001031


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