title: [Serotonin syndrome caused by an overdose of dextromethorphan, Medicon].
abstract: We report the first case of serotonin syndrome caused by overdose of dextromethorphan in Japan. A 34-year-old woman with schizophrenia received a dextromethorphan (Medicon) for a catarrhal symptom from two individual departments of the university hospital by chance. The daily amount of dextromethorphan was up to 180 mg for several days in addition to other regular antipsychotic drugs including risperidone, amitriptyline and levomepromazine. Finally, she was found in deep comatose state (GCS coma scale: E1V1M1) and the trachea was intubated in the emergency room. After admission to intensive care unit, the consciousness gradually improved; however, she was confused and agitated. The situation was normalized within next 24 hours and she was weaned from the mechanical ventilation next day. Serotonin syndrome demonstrates various signs and might be overlooked in an emergency room. Dextromethorphan is considered as a safe antitussive drug; however, the unexpected interaction should be suspected during chronic medical treatment.
authors.affiliation: Intensive Care Unit of University Hospital, Hamamatsu University School of Medicine, Hamamatsu 431-3192.
authors.forename: Yushi
authors.initials: Y
authors.lastname: Adachi
authors.forename: Sakiko
authors.initials: S
authors.lastname: Uchisaki
authors.forename: Taiga
authors.initials: T
authors.lastname: Itagaki
authors.forename: Katsumi
authors.initials: K
authors.lastname: Suzuki
authors.forename: Yukako
authors.initials: Y
authors.lastname: Obata
authors.forename: Matsuyuki
authors.initials: M
authors.lastname: Doi
authors.forename: Shigehito
authors.initials: S
authors.lastname: Sato
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000009:adverse effects; D000996:Antitussive Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000506:poisoning*; D003915:Dextromethorphan / Q000008:administration & dosage / Q000009:adverse effects / Q000506:poisoning*; D004347:Drug Interactions; D062787:Drug Overdose; D018691:Excitatory Amino Acid Antagonists / Q000008:administration & dosage / Q000009:adverse effects / Q000506:poisoning*; D005260:Female; D006801:Humans; D020230:Serotonin Syndrome / Q000139:chemically induced*
chemical_list: D014150:Antipsychotic Agents; D000996:Antitussive Agents; D018691:Excitatory Amino Acid Antagonists; D003915:Dextromethorphan