CASE REPORT SEROTONIN SYNDROME DUE TO DRUG INTERACTIONS

SANGLAH HOSPITAL, BALI

I Putu Diatmika1), I Gusti Ayu Indah Ardani2) Ni Ketut Sri Diniari2)

Background: Serotonin syndrome (serotonin syndrome (SS)) caused by excessive serotonergic activity in
the central and peripheral nervous system. SS often characterized by three clinical manifestations of the
change in mental status, autonomic hyperactivity, and neuromuscular abnormalities. SS is an important
clinical problem due to the discovery of many new anti-depressant. SS arising after an increase in the
dose of medication or taking a new medication. Some medications associated with SS is monoamine
oxidase inhibitors (MAOIs), tricyclic antidepresans (TCAs), selective serotonin reuptake inhibitors
(SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), there are several other types of drugs can
also trigger
seritonin syndrome.

Methods: Female, 31 years consulted for feeling sad, dispirited and complained to quickly tired it felt
since being diagnosed with a malignant tomor buttocks area. Complaints perceived been experienced
since 1 month before consulted. Patients diagnosed with episodes of major depression without psychotic
symptoms and get treatment Fluoxetine 10 mg @ 24 hours and clobazam 10 mg @ 24 hours after the
treatment and suspected infection patients were cultured with the results of sensitive patients with
Linezolid 600 mg intravenously after 1 day of administration of patients experience agitation , increased
blood pressure, fever and stiffness in the lower extremity.

Results: The combination of Fluoxetine as the antidepressant class selective serotonin reuptake inhibitors
(SSRIs) with antibiotic Linezolid that have pharmacokinetic mechanism works on monoamine oxidase
(MOA) increase the risk of serotonin syndrome.

Conclusion: Serotonin syndrome (serotonin syndrome (SS)) caused by excessive serotonergic activity in
the central and peripheral nervous system. SS often characterized by three clinical picture that changes in
mental status, autonomic hyperactivity, and neuromuscular abnormalities. The combination of SSRIs and
MAO increase the risk of serotonin syndrome.

Keywords: Serotonin syndrome, Drug Interactions.

1) Resident of Psychiatry, Medical Faculty of Udayana University / Sanglah Hospital, Denpasar

2) Psychiatrists, Medical Faculty of Udayana University / Sanglah Hospital, Denpasar