Table 3.
Drugs associated with development of serotonin syndrome, classified according to their mechanism of action.
| Synthesis and Release | |||
| Increase Serotonin Synthesis | Dietary supplements: L-tryptophan | ||
| Increase Serotonin Release | Psychostimulants: Amphetamines, phentermine, MDMA Antidepressants: mirtazapine Opioids: meperidine, oxycodone, tramadol Cough suppressants: dextromethorphan |
||
| Metabolism | |||
| Inhibit Serotonin Uptake | Psychostimulants: Amphetamines, MDMA, cocaine Antidepressants: trazodone SNRI: desvenlafaxine, duloxetine, venlafaxine SSRI: citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline TCA: amitriptyline, amoxapine, clomipramine, desipramine, doxepin, imipramine, maprotiline, nortriptyline, protriptyline, trimipramine Opioids: meperidine, methadone, tramadol Cough suppressants: dextromethorphan |
||
| Inhibit Serotonin Metabolism | Anxiolytics: buspirone MAOI: furazolidone, isocarboxazid, linezolid, methylene blue, phenelzine, selegiline, tranylcypromine |
||
| Inhibit Cytochrome P450 Microsomal Oxidases | CYP2D6 | CYP3A4 | CYP2C19 |
| Inhibitors: fluoxetine, sertraline Substrates: dextromethorphan, oxycodone, risperidone, tramadol |
Inhibitors: ciprofloxacin, ritonavir Substrates: methadone, oxycodone, venlafaxine |
Inhibitors: fluconazole Substrates: citalopram |
|
| Receptor Activation | |||
| Activate Serotonin Receptors | Hallucinogen: LSD Anxiolytics: buspirone Antidepressants: trazodone Opioids*: fentanyl, meperidine Mood stabilizers: lithium |
||