title: Serotonin toxicity: a short review of the literature and two case reports involving citalopram.
abstract: The serotonin toxicity (ST) is a potentially life-threatening adverse drug reaction results from therapeutic drug use, intentional self-poisoning, or inadvertent interactions between drugs. ST can be caused by a single or a combination of drugs with serotonergic activity due to excessive serotonergic agonism on central nervous system and peripheral serotonergic receptors (monoamine oxidase inhibitors, tricyclic antidepressants, SSRIs, opiate analgesics, over-the-counter cough medicines, antibiotics, weight-reduction agents, antiemetics, antimigraine agents, drugs of abuse, H2-antagonist and herbal products). The serotonin toxicity is often described as a clinical triad of mental-status changes (agitation and excitement with confusion), autonomic hyperactivity (diaphoresis, fever, tachycardia, and tachypnea), neuromuscular abnormalities (tremor, clonus, myoclonus, and hyperreflexia) and, in the advanced stage, spasticity; not all of these findings are consistently present. In this article, we describe two cases of ST due to interaction between Citalopram and two CYP2D6 inhibitors: Cimetidine and Topiramate and their clinical resolution after treatment discontinuation.
authors.affiliation: Memory Clinic, Department of Neurological Science, University La Sapienza, Viale dell'Università 30, 00185 Rome, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Talarico
authors.forename: G
authors.initials: G
authors.lastname: Tosto
authors.forename: S
authors.initials: S
authors.lastname: Pietracupa
authors.forename: E
authors.initials: E
authors.lastname: Piacentini
authors.forename: M
authors.initials: M
authors.lastname: Canevelli
authors.forename: G L
authors.initials: GL
authors.lastname: Lenzi
authors.forename: G
authors.initials: G
authors.lastname: Bruno
mesh_terms: D000368:Aged; D002927:Cimetidine / Q000008:administration & dosage / Q000009:adverse effects; D015283:Citalopram / Q000008:administration & dosage / Q000009:adverse effects*; D019389:Cytochrome P-450 CYP2D6 / Q000502:physiology; D065690:Cytochrome P-450 CYP2D6 Inhibitors; D005260:Female; D005632:Fructose / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives; D006801:Humans; D008297:Male; D020230:Serotonin Syndrome / Q000139:chemically induced* / Q000175:diagnosis* / Q000378:metabolism; D017367:Selective Serotonin Reuptake Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D000077236:Topiramate
chemical_list: D002927:Cimetidine; D015283:Citalopram; D019389:Cytochrome P-450 CYP2D6; D065690:Cytochrome P-450 CYP2D6 Inhibitors; D005632:Fructose; D017367:Selective Serotonin Reuptake Inhibitors; D000077236:Topiramate