A case of serotonin syndrome precipitated by duloxetine in a patient with zoster-associated pain

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  • WAJIMA Zen'ichiro
    Department of Anesthesiology, International University of Health and Welfare Shioya Hospital Department of Anesthesiology, International University of Health and Welfare Hospital
  • SHIGA Toshiya
    Department of Anesthesiology, Kaken Hospital, International University of Health and Welfare

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Other Title
  • デュロキセチン投与をきっかけにセロトニン症候群と思われる症状を呈した帯状疱疹関連痛の1症例
  • 症例 デュロキセチン投与をきっかけにセロトニン症候群と思われる症状を呈した帯状疱疹関連痛の1症例
  • ショウレイ デュロキセチン トウヨ オ キッカケ ニ セロトニン ショウコウグン ト オモワレル ショウジョウ オ テイシタ タイジョウホウシンカンレンツウ ノ 1 ショウレイ

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Serotonin syndrome is an adverse reaction caused by the therapeutic use or overdose of serotonergic drugs, alone or in combination, that results from postsynaptic hyperstimulation of 5-hydroxytryptamine (5-HT) 2A and 1A serotonin receptors in the central and peripheral nervous systems. Serotonin syndrome presents as a constellation of symptoms that include changes in mental status, neuromuscular overactivity, and autonomic instability. We report a case of serotonin syndrome primarily caused by duloxetine, a serotonin-norepinephrine reuptake inhibitor, which was administered to treat zoster-associated pain. We administered tramadol to the patient as treatment at the same time, and this coadministration may have induced serotonin syndrome. Many opioids, such as tramadol, oxycodone, fentanyl, codeine, buprenorphine, and dextromethorphan, which are reported to be serotonergic, are implicated in causing serotonin syndrome in combination with other serotonergic agents. Serotonin syndrome is a rare, but potentially life-threatening, iatrogenic complication, and physician awareness needs to be directed toward this syndrome.

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