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Anesth Analg 2006;103:1466-1468
© 2006 International Anesthesia Research Society
doi: 10.1213/01.ane.0000247699.81580.eb

ANESTHETIC PHARMACOLOGY

Serotonin Syndrome from the Interaction of Cyclobenzaprine with Other Serotoninergic Drugs

Mark T. Keegan, MD*, Daniel R. Brown, MD, PhD, FCCM*, and Alejandro A. Rabinstein, MD{dagger}

From the Departments of *Anesthesiology and {dagger}Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota.

Address correspondence and reprint requests to Alejandro A. Rabinstein, MD, 200 First Str. SW, Mayo W8, Rochester, MN 55905. Address e-mail to rabinstein.alejandro{at}mayo.edu.

Serotonin syndrome is a potentially lethal adverse drug reaction that may occur in patients taking proserotoninergic medications. Drug interactions are often responsible for the causation of this syndrome. We report two cases of severe serotonin syndrome induced by the administration of cyclobenzaprine in postoperative patients already receiving another proserotoninergic drug (phenelzine in one case and duloxetine in the other). In both cases, symptoms of autonomic instability and severe agitation started within hours of initiation of cyclobenzaprine and fully resolved within 3 days after discontinuing the proserotoninergic drugs. We conclude that cyclobenzaprine should be used with extreme caution in patients receiving other serotonin-enhancing drugs; these patients should be closely monitored for manifestations of serotonin syndrome.






Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2006 by the International Anesthesia Research Society.