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Serotonin Syndrome Following Combined Administration of Dopaminergic and Noradrenergic Agents in a Patient With Akinetic Mutism After Frontal Intracerebral Hemorrhage: A Case Report

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Title: Serotonin Syndrome Following Combined Administration of Dopaminergic and Noradrenergic Agents in a Patient With Akinetic Mutism After Frontal Intracerebral Hemorrhage: A Case Report
Authors: Yong Wook Kim, Dae Geun Jeon, Nayoung Kim, Jung Hyun Park
Contributors: College of Medicine, Dept. of Rehabilitation Medicine, Jeon, Dae Geun, Kim, Yong Wook, Kim, Na Young, Park, Jung Hyun
Source: Clinical Neuropharmacology. 40:180-182
Publisher Information: Ovid Technologies (Wolters Kluwer Health), 2017.
Publication Year: 2017
Subject Terms: Male, Serotonin Syndrome, Levodopa/administration & dosage, Methylphenidate/adverse effects, Dopamine Agents, Adrenergic Uptake Inhibitors/adverse effects, Atomoxetine Hydrochloride, Dopamine Uptake Inhibitors/adverse effects, Akinetic Mutism/diagnostic imaging, Levodopa, Benserazide, 03 medical and health sciences, 0302 clinical medicine, Drug Therapy, Dopamine Uptake Inhibitors, Benserazide/administration & dosage, Serotonin Syndrome/complications, Humans, Methylphenidate/administration & dosage, Cerebral Hemorrhage, Atomoxetine Hydrochloride/adverse effects, Adrenergic Uptake Inhibitors/administration & dosage, Levodopa/adverse effects, Adrenergic Uptake Inhibitors, Akinetic Mutism/drug therapy, Dopamine Agents/adverse effects, Middle Aged, Cerebral Hemorrhage/complications, Dopamine Uptake Inhibitors/administration & dosage, Middle Aged Serotonin Syndrome/chemically induced, Dopamine Agents/administration & dosage, 3. Good health, Akinetic Mutism, Drug Combinations, Akinetic Mutism/etiology, Combination, Serotonin Syndrome/diagnostic imaging, Methylphenidate, Cerebral Hemorrhage/diagnostic imaging, Drug Therapy, Combination, Atomoxetine Hydrochloride/administration & dosage, Benserazide/adverse effects, Cerebral Hemorrhage/drug therapy
Description: BackgroundSerotonin syndrome (SS) is a potentially life-threatening condition that can be caused by use of proserotonergic drugs. Several studies have reported that combined administration of various medications may induce SS. We report a case of SS in a patient who was being treated with dopaminergic and noradrenergic drugs.Case PresentationA 55-year-old man with a right frontal intracerebral hemorrhage extending to the left cerebral hemisphere presented with clinical features of akinetic mutism. Three months after onset, dopaminergic (methylphenidate, levodopa/benserazide) and noradrenergic (atomoxetine) drugs were administered to enhance his cognitive function. His cognitive function gradually improved during 8 weeks of dose escalation. One day after the dose of atomoxetine was increased from 40 mg/d to 60 mg/d, the patient developed inducible clonus, rigidity, diarrhea, tachycardia, and hyperthermia, in keeping with a diagnosis of SS. The symptoms and signs suggestive of SS resolved on the day following cessation of all dopaminergic and noradrenergic drugs.ConclusionsThis case demonstrates that medications generally known as dopaminergic or noradrenergic agents could have serotonergic effects via a mechanism that is yet to be fully elucidated. The clinical manifestations of SS can be diverse, ranging from mild to severe and potentially fatal symptoms. When administering a combination of catecholaminergic agents, clinicians should carefully monitor the patient’s neurologic status for unexpected adverse reactions.
Document Type: Article
Language: English
ISSN: 1537-162X
0362-5664
DOI: 10.1097/wnf.0000000000000220
Access URL: https://pubmed.ncbi.nlm.nih.gov/28622210
https://ir.ymlib.yonsei.ac.kr/handle/22282913/160513
https://www.ncbi.nlm.nih.gov/pubmed/28622210
https://pubmed.ncbi.nlm.nih.gov/28622210/
Rights: CC BY NC ND
Accession Number: edsair.doi.dedup.....9290a9f04ffb2f7089a75c5d53d87c1a
Database: OpenAIRE
Description
Abstract:BackgroundSerotonin syndrome (SS) is a potentially life-threatening condition that can be caused by use of proserotonergic drugs. Several studies have reported that combined administration of various medications may induce SS. We report a case of SS in a patient who was being treated with dopaminergic and noradrenergic drugs.Case PresentationA 55-year-old man with a right frontal intracerebral hemorrhage extending to the left cerebral hemisphere presented with clinical features of akinetic mutism. Three months after onset, dopaminergic (methylphenidate, levodopa/benserazide) and noradrenergic (atomoxetine) drugs were administered to enhance his cognitive function. His cognitive function gradually improved during 8 weeks of dose escalation. One day after the dose of atomoxetine was increased from 40 mg/d to 60 mg/d, the patient developed inducible clonus, rigidity, diarrhea, tachycardia, and hyperthermia, in keeping with a diagnosis of SS. The symptoms and signs suggestive of SS resolved on the day following cessation of all dopaminergic and noradrenergic drugs.ConclusionsThis case demonstrates that medications generally known as dopaminergic or noradrenergic agents could have serotonergic effects via a mechanism that is yet to be fully elucidated. The clinical manifestations of SS can be diverse, ranging from mild to severe and potentially fatal symptoms. When administering a combination of catecholaminergic agents, clinicians should carefully monitor the patient’s neurologic status for unexpected adverse reactions.
ISSN:1537162X
03625664
DOI:10.1097/wnf.0000000000000220