TABLE 1.
Serotonin-Elevating Medications
| SRIs | SGA | Opioids | Illicit Drugs | OTC/Herbals | Disputeda |
|---|---|---|---|---|---|
| SSRIs | Ziprasidone | Meperidine | MDMA/Ecstasy | St. John’s Wort | Antidepressants |
| (es)citalopram | Amitriptyline | ||||
| Fluoxetine | Methadone | Cocaine | L-tryptophan | Mirtazepine | |
| Fluvoxamine | Trazodone | ||||
| Paroxetine | Pentazocine | Amphetamines | Ginseng | Nefazodone | |
| Sertraline | Bupropion | ||||
| Vilazodone | Pethidine | Methamphetamine | Dextromethorphan | ||
| Vortioxetine | |||||
| Tramadol | Phentermine | S-adenosyl-L-methionine (SAMe) | Antiemetics | ||
| SNRIs | Ondansetron | ||||
| (des)venlafaxine | LSD (lysergic acid diethylamide) | Metoclopramide | |||
| Duloxetine | Chlorpheniramine | ||||
| (levo)milnacipran | Tryptans | ||||
| Bath salts | Brompheniramine | ||||
| TCAs | Buspirone | ||||
| Clomipramine | |||||
| Imipramine | Olanzapine | ||||
| MAOIs | Lithium | ||||
| Moclobemide | |||||
| Isocarboxazid | Fentanyl | ||||
| Phenelzine | |||||
| Tranylcypromine | Methylphenidate | ||||
| Methylene blue | |||||
| Linezolid (weak) | Cyclobenzaprine | ||||
| Isoniazid (weak) | |||||
| Metaxolone (weak) |
Abbreviations: LSD, lysergic acid diethylamide; MAOIs, monoamine oxidase inhibitors; MDMA, methylenedioxymethamphetamine; OTC, over-the-counter; SGA, second-generation antipsychotics; SNRIs, selective norepinephrine reuptake inhibitors; SRI, serotonin reuptake inhibitor; SSRIs, selective serotonin reuptake inhibitors; TCAs, tricyclic antidepressants.
a
Disputed-experts disagree on these medications causing serotonin syndrome/toxicity because of their mechanisms of action.