What are the most common serotonin syndrome symptoms?
Symptoms of serotonin syndrome and their severity vary from person to person. They can be mild to severe to even fatal.
If you’re taking a medication that affects serotonin and experience any of the following symptoms, call your healthcare provider or visit an urgent or emergency care facility right away.
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Mild symptoms
- Nervousness.
- Nausea, vomiting.
- Diarrhea.
- Dilated pupils.
- Tremor.
Moderate symptoms
- Agitation, restlessness.
- Muscle twitching, involuntary muscle contractions, muscle spasms, muscle rigidity.
- Sweating, shivering.
- Abnormal (side-to-side) eye movements.
Severe symptoms
- Confusion, disorientation, delirium.
- Rapid heart rate.
- High blood pressure.
- High body temperature (greater than 101.3 Fahrenheit [38.5 Celsius]).
- Seizures.
- Abnormal heartbeat.
- Passing out, fainting.
How quickly do symptoms of serotonin syndrome develop?
Symptoms usually begin within a few hours of taking a new medication that affects serotonin levels or increasing the dose of a drug you’re already taking. Nearly all people will experience symptoms within 24 hours of starting, adding or increasing the dosage of a serotonergic medication or product.
What causes serotonin syndrome?
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A rise in serotonin levels in your body causes serotonin syndrome. This increase in serotonin can happen if you:
- Take more than one medication that affects serotonin levels.
- Recently started on a medication or increased the dose of a medication known to increase serotonin levels.
- Take too much of one serotonin-related medication, accidentally or on purpose.
- Use certain illegal drugs or herbal products or over-the-counter drugs that affect serotonin levels.
What medications and other products affect serotonin levels and could cause serotonin syndrome?
Antidepressants
Antidepressants are the most commonly used medications that affect serotonin levels. When involved in serotonin syndrome, they’re often used with other serotonergic drugs that treat other conditions; for example, triptan migraine drugs or opioid pain medications.
Antidepressant drug classes and medication examples that can increase serotonin levels include:
- Selective serotonin reuptake inhibitors (SSRIs): This class includes fluoxetine (Prozac®), citalopram (Celexa®), sertraline (Zoloft®), paroxetine (Paxil®) and escitalopram (Lexapro®). This drug class is the most common antidepressant class involved in serotonin syndrome due to its widespread use.
- Serotonin-norepinephrine reuptake inhibitors (SNRIs): This class includes duloxetine (Cymbalta®), venlafaxine (Effexor®), desvenlafaxine (Pristiq), levomilnacipran (Fetzima) and milnacipran (Savella).
- Tricyclic antidepressants: This class includes amitriptyline (Elavil®), clomipramine (Anafranil®), nortriptyline (Pamelor®), desipramine (Norpramin®), doxepin (Sinequan®), imipramine (Tofranil®) and trimipramine (Surmontil®).
- Monoamine oxidase inhibitors: This class includes phenelzine (Nardil®), selegiline (Emsam®) and tranylcypromine (Parnate®).
- Serotonin modulators: This class includes nefazodone and trazodone (Desyrel®).
- Norepinephrine reuptake inhibitor: This class includes bupropion (Wellbutrin®).
Other medications
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Other medications can also affect your body’s serotonin level, especially when combined with other drugs that affect serotonin. These medications treat:
- Severe pain: Drugs in this category include opioids like tramadol (Ultram®), meperidine (Demerol®), tapentadol (Nucynta®), hydrocodone (Hysingla ER®), oxycodone (Oxyxontin®), fentanyl (Actiq®) and methadone.
- Coughing: Over-the-counter (OTC) cough and cold medications containing dextromethorphan can affect serotonin levels.
- Migraine headaches: Headache drugs in the triptan family include almotriptan (Axert®), eletriptan (Relpax®), frovatriptan (Frova®), rizatriptan (Maxalt®), sumatriptan (Imitrex®) and zolmitriptan (Zomig®).
- HIV/AIDS: Ritonavir (Norvir®).
- Antibiotic: Linezolid (Zyvox®).
- Anti-nausea medications: Metoclopramide (Reglan®), granisetron (Sustol®), droperidol (Inapsine®) and ondansetron (Zofran®).
- Mood stabilizer: Lithium (Lithobid®).
Other products
Other herbal and dietary supplements and illegal substances that affect serotonin levels and could cause serotonin syndrome include:
- Herbal supplements: These can include ginseng, St. John’s wort, Syrian rue and nutmeg.
- Illegal substances: These substances include ecstasy, LSD, cocaine, amphetamines and methamphetamines.
- Dietary supplement: Tryptophan.
Medical experts still have much to learn about serotonin syndrome. If you have concerns about the possible serotonin-affecting medications you take, talk to your healthcare provider or local pharmacist.
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