Posted by jedi on December 15, 2007, at 22:07:44
In reply to Re: MAOIs and WEAK SRIs combination?, posted by torachan on December 15, 2007, at 16:55:09
> I thought serotonin syndrome was only a danger when combining two serotinergic drugs like SSRI's. Do MAOI's affect serotonin?
Yes, and the combination of say a MAOI and a SSRI is even more dangerous because they affect serotonin in different ways. The combination can result in serotonin toxicity which is indeed life threatening.
JediReference:
Br J Anaesth. 2005 Oct;95(4):434-41. Epub 2005 Jul 28.
Monoamine oxidase inhibitors, opioid analgesics and serotonin toxicity. Gillman PK.
Pioneer Valley Private Hospital, Mackay, Queensland, Australia. kg@matilda.net.auToxicity resulting from excessive intra-synaptic serotonin, historically referred to as serotonin syndrome, is now understood to be an intra-synaptic serotonin concentration-related phenomenon. Recent research more clearly delineates serotonin toxicity as a discreet toxidrome characterized by clonus, hyper-reflexia, hyperthermia and agitation. Serotonergic side-effects occur with serotonergic drugs, and overdoses of serotonin re-uptake inhibitors (SRIs) frequently produce marked serotonergic side-effects, and in 15% of cases, moderate serotonergic toxicity, but not to a severe degree, which produces hyperthermia and risk of death. It is only combinations of serotonergic drugs acting by different mechanisms that are capable of raising intra-synaptic serotonin to a level that is life threatening. The combination that most commonly does this is a monoamine oxidase inhibitor (MAOI) drug combined with any SRI. There are a number of lesser-known drugs that are MAOIs, such as linezolid and moclobemide; and some opioid analgesics have serotonergic activity. These properties when combined can precipitate life threatening serotonin toxicity. Possibly preventable deaths are still occurring. Knowledge of the properties of these drugs will therefore help to ensure that problems can be avoided in most clinical situations, and treated appropriately (with 5-HT(2A) antagonists for severe cases) if they occur. The phenylpiperidine series opioids, pethidine (meperidine), tramadol, methadone and dextromethorphan and propoxyphene, appear to be weak serotonin re-uptake inhibitors and have all been involved in serotonin toxicity reactions with MAOIs (including some fatalities). Morphine, codeine, oxycodone and buprenorphine are known not to be SRIs, and do not precipitate serotonin toxicity with MAOIs.
PMID: 16051647 [PubMed - indexed for MEDLINE]
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thread:800899
URL: http://www.dr-bob.org/babble/20071213/msgs/801069.html