Serotonin syndrome and the triptans

Abstract

Serotonin syndrome (SS) is a potentially life-threatening adverse drug reaction that can result from interaction between two or more serotoninergic drugs and even from the use of a single serotoninergic drug. This condition is an acute toxic reaction to substances that enhance serotoninergic activity at certain synapses either within the central or the periphery. Clinical features of SS consist of the triad: altered mental status, autonomic hyperactivity and neuromuscular abnormalities. The severity of SS cases ranges from mild to fatal. This syndrome has a rapid onset and, in most of the cases, is a self-limiting condition that improves on cessation of the offending drugs. In 2006, US Food and Drug Administration (FDA) issued an alert about the presumptive ocurrence of SS with combined use of triptans and selective serotonin re-uptake inhibitors or selective serotonin/norepinephrine re-uptake inhibitors (The so called dual selective inhibitors). Nonetheless, despite this statement, insufficient data are available to judge whether this combination actually increases the risk of serotonin syndrome.