Interaction of serotonergic antidepressants and opioid analgesics: Is serotonin syndrome going undetected?

Title

Interaction of serotonergic antidepressants and opioid analgesics: Is serotonin syndrome going undetected?

Creator

Gnanadesigan N; Espinoza RT; Smith RA; Israel M; Reuben DB

Publisher

Journal Of The American Medical Directors Association

Date

2005

Subject

Female; Humans; Analgesics; Aged; Drug Interactions; Homes for the Aged; Nursing Homes; 80 and over; Antidepressive Agents/pharmacology; Mianserin/analogs & derivatives/pharmacology; Opioid/pharmacology; Serotonin Agents/pharmacology; Serotonin Syndrome/etiology

Description

OBJECTIVES: To describe the potential for interaction between opioids and serotonergic antidepressants leading to the development of serotonin syndrome (SS), mechanism of the interaction, and the spectrum of SS in elderly residents of a long-term care facility. DESIGN: Case series. SETTING: Long-term care facility (LTCF) in California. PARTICIPANTS: Four elderly LTCF residents treated with serotonergic antidepressants including selective serotonin reuptake inhibitor (SSRI) or mirtazapine and opioids. MEASUREMENTS: Signs and symptoms suggestive of SS. RESULTS: We describe 4 cases of probable SS among elderly residents of a LTCF. The spectrum of serotonin toxicity ranged from visual hallucinations, muscle rigidity, myoclonus, or hypertension in patients taking an opiate with an SSRI to lethargy, hypotension, and hypoxia in a patient taking tramadol and mirtazapine. CONCLUSION: While many can benefit from coadministration of serotonergic antidepressants and opioids, it appears that some individuals are at increased risk for SS. Since SS is a clinical diagnosis, heightened clinician awareness of the possibility of SS among patients receiving SSRI or mirtazapine in combination with opioids may lead to earlier detection and avoidance of potentially lethal consequences.
2005

Rights

Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).

Type

Journal Article

Citation List Month

Backlog

Pages

265-269

Issue

4

Volume

6

Citation

Gnanadesigan N; Espinoza RT; Smith RA; Israel M; Reuben DB, “Interaction of serotonergic antidepressants and opioid analgesics: Is serotonin syndrome going undetected?,” Pediatric Palliative Care Library, accessed May 19, 2022, https://pedpalascnetlibrary.omeka.net/items/show/13717.

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