Confused about which drugs
cause serotonin syndrome?
Here’s a quick review.
First, serotonin syndrome is typically caused
by a drug interaction or overdose.
Second, the highest risk drugs are the
monoamine oxidase inhibitors or “MAOi’s.”
MAOi’s include the antidepressants tranylcypromine,
phenylzine, isocarboxazid, and moclobemide;
the anti-infectives linezolid and isoniazid;
the Parkinson’s medications selegiline and rasagiline;
and the old and rarely used methylene blue.
Third, serotonin syndrome is most likely
to occur when two MAOi’s are used together
or when an MAOi is used with another serotonin drug.
Other serotonin drugs include:
antidepressants including SSRIs, SNRIs,
and certain tricyclic antidepressants;
pain relievers tramadol, methadone,
meperidine, and fentanyl;
dextromethorphan (DM) and clorpheniramine;
St. John’s Wort, L-tryptophan and diet pills;
and ecstasy (or MDMA) and cocaine.
Fourth, while serotonin syndrome is most common
with MAOi’s, it can happen when any two
serotonin drugs are used together.
Especially when one is being used at a high dose.
Finally, the following drugs tend to trigger
system alerts but their mechanisms of action
mean they are unlikely to cause serotonin syndrome.
These include: antidepressants
trazodone, mirtazapine and amitriptyline;
triptan migraine medications;
anti-emetics ondansetron and metoclopramide;
and other medications including
lithium, buspirone, ritonavir and amphetamine.
