title: Serotonin syndrome after the use of tramadol and ziprasidone in a patient with a deep brain stimulator for Parkinson disease.
abstract: Serotonin syndrome (SS) is a life-threatening adverse reaction that can result from the therapeutic use of serotonergic drugs or accidental drug interactions. Tramadol is a drug that is widely prescribed because of its low abuse potential, but physicians need to be aware of its significant potential to cause SS because it inhibits serotonin reuptake. Ziprasidone is an atypical antipsychotic that can also cause dangerous interactions to cause SS because it is not only a potent 5-HT1A agonist but also has been reported to inhibit serotonin reuptake with an affinity similar to tricyclic antidepressants, in addition to inhibiting reuptake of norepinephrine. We are describing the clinical characteristics of a gentleman with bipolar disorder and Parkinson disease who presented with SS, despite having a deep brain stimulator in the subthalamic nucleus, which decreases central serotonin levels, and a discussion of the factors that contributed to his presentation.
authors.affiliation: Department of Medicine, University of Toledo, Toledo, OH.
authors.forename: Nasser Samir
authors.initials: NS
authors.lastname: El-Okdi
authors.forename: Daniel
authors.initials: D
authors.lastname: Lumbrezer
authors.forename: Djuro
authors.initials: D
authors.lastname: Karanovic
authors.forename: Abhimanyu
authors.initials: A
authors.lastname: Ghose
authors.forename: Ragheb
authors.initials: R
authors.lastname: Assaly
mesh_terms: D000368:Aged; D000701:Analgesics, Opioid / Q000009:adverse effects / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000188:drug therapy; D046690:Deep Brain Stimulation / Q000379:methods; D004347:Drug Interactions; D006801:Humans; D008297:Male; D010300:Parkinson Disease / Q000628:therapy; D010879:Piperazines / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use; D012701:Serotonin / Q000378:metabolism*; D020230:Serotonin Syndrome / Q000139:chemically induced*; D013844:Thiazoles / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use; D014147:Tramadol / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use
chemical_list: D000701:Analgesics, Opioid; D014150:Antipsychotic Agents; D010879:Piperazines; D013844:Thiazoles; D012701:Serotonin; D014147:Tramadol; C092292:ziprasidone