olanzapine and Serotonin-Syndrome

Serotonin syndrome is a potentially life-threatening complication of serotonergic agents. Although mirtazapine is a relatively safe antidepressant and has a comparatively low incidence of side effects, it still could induce serotonin syndrome.. We described a 34-year-old man with schizophrenic disorder who presented with acute consciousness disturbance, extremely high fever, rigidity, and spontaneous clonus in lower limbs. Two days before entry, oral mirtazapine was added to his regular medication of olanzapine. The serotonin-related symptoms resolved soon after withdrawal of mirtazapine and olanzapine combined with treatment with intravenous benzodiazepine and oral cyproheptadine. However, the clinical course was complicated by rhabdomyolysis, acute renal failure, and acute pulmonary edema. After receiving mechanical ventilation, hemodialysis, and appropriate supportive treatment, his general condition recovered and he was discharged without any neurological sequelae.. With the increasing use of serotonergic agents, awareness of serotonin syndrome is important. Early diagnosis and timely discontinuation of the offending agent(s) are imperative to prevent morbidity and mortality.

Topics: Acute Disease; Acute Kidney Injury; Adult; Benzodiazepines; Humans; Male; Mianserin; Mirtazapine; Olanzapine; Pulmonary Edema; Rhabdomyolysis; Serotonin Syndrome

Serotonin syndrome and neuroleptic malignant syndrome are two drug toxidromes that have often overlapping and confusing clinical pictures. We report a case of a young man who presented with alteration of mental status, autonomic instability and neuromuscular hyperexcitability following ingestion of multiple psychiatric and antiepileptic medications. The patient satisfied criteria for serotonin syndrome and neuroleptic malignant syndrome, and based on the characteristic clinical features, laboratory findings and clinical course it was concluded that the patient had both toxidromes. The patient was managed with cyproheptadine and supportive measures, and recovered over the course of 3 weeks. A brief review of literature highlighting the diagnostic clues as well as the importance of recognising and distinguishing the often missed and confounding diagnoses follows.

Topics: Antimanic Agents; Antipsychotic Agents; Benzodiazepines; Clonazepam; Diagnosis, Differential; GABA Modulators; Humans; Lithium Compounds; Male; Neuroleptic Malignant Syndrome; Olanzapine; Risperidone; Serotonin Syndrome; Valproic Acid; Young Adult

BACKGROUND Serotonin syndrome is a condition characterized predominantly by neuromuscular symptoms and altered thermoregulation in response to serotonergic overtone. Treatment is focused on withdrawal of serotonergic agents, which leads to resolution in the majority of cases. In the setting of serotonergic overdose, the onset of serotonin syndrome is usually within 4 to 13 h. Here, we report a case of delayed-onset serotonin syndrome in a patient who ingested a mixture of longer-acting serotonin agonists with serotonin antagonists. CASE REPORT A 24-year-old male was transferred to our medical intensive care unit with hypotension and altered mental status after an overdose of fluoxetine, cyproheptadine, trazodone, olanzapine, risperidone, and bupropion. After approximately 72 h, the patient developed symptoms of fever, lower leg clonus, hyperreflexia, and agitation. He was diagnosed with delayed-onset serotonin syndrome, which responded well to re-administration of cyproheptadine, leading to resolution of symptoms by day 5 of his stay. CONCLUSIONS In this present case, our patient presented with the longest reported delay in the onset of serotonin syndrome after intentional ingestion. This was likely secondary to co-ingestion of long-acting serotonin agonists with protective shorter-acting serotonin antagonists (cyproheptadine and olanzapine). Clinicians should consider delayed-onset serotonin syndrome when patients ingest longer-acting serotonergic agents with serotonin antagonists.

Topics: Benzodiazepines; Bupropion; Cyproheptadine; Dopamine Uptake Inhibitors; Drug Overdose; Fluoxetine; Humans; Male; Olanzapine; Risperidone; Selective Serotonin Reuptake Inhibitors; Serotonin Agents; Serotonin Antagonists; Serotonin Receptor Agonists; Serotonin Syndrome; Time Factors; Trazodone; Young Adult

Topics: Benzodiazepines; Depressive Disorder; Duloxetine Hydrochloride; Female; Humans; Middle Aged; Olanzapine; Selective Serotonin Reuptake Inhibitors; Serotonin Syndrome; Thiophenes

Topics: Benzodiazepines; Female; Humans; Middle Aged; Olanzapine; Receptors, Serotonin; Selective Serotonin Reuptake Inhibitors; Serotonin Syndrome

We describe a full-term infant with failed respiratory effort and decerebrate posturing following in utero exposure to paroxetine. All signs and symptoms associated with the paroxetine exposure were resolved by the second day of life. Upon discharge, the infant revealed a normal neurodevelopmental examination.

Topics: Antidepressive Agents, Second-Generation; Benzodiazepines; Clonazepam; Humans; Infant, Newborn; Male; Neonatal Abstinence Syndrome; Olanzapine; Paroxetine; Respiratory Insufficiency; Serotonin Syndrome

This case report describes a patient with treatment-resistant depression treated with fluoxetine and olanzapine who developed serotonin syndrome.

Topics: Benzodiazepines; Fluoxetine; Humans; Male; Middle Aged; Olanzapine; Selective Serotonin Reuptake Inhibitors; Serotonin Syndrome

Topics: Benzodiazepines; Fluoxetine; Humans; Olanzapine; Selective Serotonin Reuptake Inhibitors; Serotonin Syndrome

Topics: Antipsychotic Agents; Benzodiazepines; Citalopram; Drug Therapy, Combination; Humans; Olanzapine; Paroxetine; Pirenzepine; Risk Factors; Selective Serotonin Reuptake Inhibitors; Serotonin Syndrome; Substance Withdrawal Syndrome

The present paper describes a case of serotonin syndrome (SS), which developed in a patient with bipolar affective disorder after the addition of olanzapine to her regimen of lithium and citalopram. This appears to be the first report that implicates olanzapine with SS. Clinicians should be aware of the risk of SS when adding atypical antipsychotics, such as olanzapine, to serotonergic agents.

Topics: Antipsychotic Agents; Benzodiazepines; Bipolar Disorder; Citalopram; Female; Humans; Lithium Chloride; Middle Aged; Olanzapine; Pirenzepine; Risk Factors; Selective Serotonin Reuptake Inhibitors; Serotonin Syndrome

Topics: Antidepressive Agents, Tricyclic; Antipsychotic Agents; Benzodiazepines; Depressive Disorder, Major; Drug Interactions; Drug Therapy, Combination; Humans; Male; Mianserin; Middle Aged; Mirtazapine; Olanzapine; Pirenzepine; Schizophrenia; Schizotypal Personality Disorder; Serotonin Syndrome; Tramadol