Multiple drugs

Multiple drugs Reactions 1704, p258 - 2 Jun 2018 Serotonin syndrome: case report A 67-year-old man developed serotonin syndrome following treatment with fentanyl, oxycodone, tramadol, citalopram, bupropion and ondansetron [routes and dosages not stated; not all indications stated]. The man, who had COPD, anxiety, depression, ischaemic cardiomyopathy, fever and acute kidney injury presented with hip fracture. An operative intervention was planned, which was delayed. He developed an elevation of INR secondary to warfarin therapy. On day three of hospitalisation, he underwent hip repair, for which, he received fentanyl. He also received oxycodone. However, he developed confusion and somnolence. Subsequently, his pain regimen was changed to tramadol from oxycodone. He continued to receive home medication, which included ondansetron, bupropion and citalopram. On the next day, he developed recurrent fever. He started receiving antibiotics along with paracetamol [Tylenol]. He developed gluteal compartment syndrome, for which he underwent emergent surgery and again received fentanyl. His mental status continued to worsen with persistent fever. Clinical examination demonstrated clonus, diaphoresis and myoclonic jerking in all extremities. Considering administration of various serotonergic drugs, a diagnosis of serotonin syndrome was made. The man’s treatment with potentially offending drugs (fentanyl, ondansetron, bupropion, tramadol and citalopram) was terminated. Subsequently, he was treated with cyproheptadine, which resulted in resolution of fever, clonus and delirium. Author comment: "Serotonin syndrome is a condition with increased serotenergic activity resulting in increased autonomic activity, mental status changes and neuromuscular hyperactivity." "This case illustrates the potential risks of prescribing multiple serotonergic agents for older patients." Yoo B, et al. Serotonin syndrome from polypharmacy. Journal of the American Geriatrics Society 66 (Suppl. 2): S95, Apr 2018. Available from: URL: http:// doi.org/10.1111/jgs.15376 [abstract] - USA 803323242 0114-9954/18/1704-0001/$14.95 Adis © 2018 Springer International Publishing AG. All rights reserved Reactions 2 Jun 2018 No. 1704 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Reactions Weekly Springer Journals

Multiple drugs

Reactions Weekly , Volume 1704 (1) – Jun 2, 2018
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Publisher
Springer Journals
Copyright
Copyright © 2018 by Springer International Publishing AG, part of Springer Nature
Subject
Medicine & Public Health; Drug Safety and Pharmacovigilance; Pharmacology/Toxicology
ISSN
0114-9954
eISSN
1179-2051
D.O.I.
10.1007/s40278-018-46901-6
Publisher site
See Article on Publisher Site

Abstract

Reactions 1704, p258 - 2 Jun 2018 Serotonin syndrome: case report A 67-year-old man developed serotonin syndrome following treatment with fentanyl, oxycodone, tramadol, citalopram, bupropion and ondansetron [routes and dosages not stated; not all indications stated]. The man, who had COPD, anxiety, depression, ischaemic cardiomyopathy, fever and acute kidney injury presented with hip fracture. An operative intervention was planned, which was delayed. He developed an elevation of INR secondary to warfarin therapy. On day three of hospitalisation, he underwent hip repair, for which, he received fentanyl. He also received oxycodone. However, he developed confusion and somnolence. Subsequently, his pain regimen was changed to tramadol from oxycodone. He continued to receive home medication, which included ondansetron, bupropion and citalopram. On the next day, he developed recurrent fever. He started receiving antibiotics along with paracetamol [Tylenol]. He developed gluteal compartment syndrome, for which he underwent emergent surgery and again received fentanyl. His mental status continued to worsen with persistent fever. Clinical examination demonstrated clonus, diaphoresis and myoclonic jerking in all extremities. Considering administration of various serotonergic drugs, a diagnosis of serotonin syndrome was made. The man’s treatment with potentially offending drugs (fentanyl, ondansetron, bupropion, tramadol and citalopram) was terminated. Subsequently, he was treated with cyproheptadine, which resulted in resolution of fever, clonus and delirium. Author comment: "Serotonin syndrome is a condition with increased serotenergic activity resulting in increased autonomic activity, mental status changes and neuromuscular hyperactivity." "This case illustrates the potential risks of prescribing multiple serotonergic agents for older patients." Yoo B, et al. Serotonin syndrome from polypharmacy. Journal of the American Geriatrics Society 66 (Suppl. 2): S95, Apr 2018. Available from: URL: http:// doi.org/10.1111/jgs.15376 [abstract] - USA 803323242 0114-9954/18/1704-0001/$14.95 Adis © 2018 Springer International Publishing AG. All rights reserved Reactions 2 Jun 2018 No. 1704

Journal

Reactions WeeklySpringer Journals

Published: Jun 2, 2018

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