Serotoninergic syndrome due to interaction between linezolid and 5-hydroxytryptophan

Ostabal Artigas, María Isabel

doi:10.1016/j.medcle.2016.04.030

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The physician attending the patients is usually unaware of this practice which can involve potentially lethal drug interactions. Recently, we have detected a case of serotonergic syndrome in a diabetic patient, discharged from hospital with oral linezolid, who started treatment with supplements of 5-hydroxytryptophan, magnesium and vitamin B6 (Obire® 5-HTP) on his own, acquired by Internet, for depressive symptoms.This is a 52-year-old male, insulin-dependent diabetic with diabetic neurovascular disease who was admitted to hospital for fever and grade 2 left foot ulcer, being treated with iv linezolid (600mg/12h) and local cures, until the third day, in which the patient requested voluntary discharge and was sent to his primary care physician with oral linezolid (600mg/12h) and ambulatory cures. Upon arrival home he began taking 5-hydroxytryptophan supplements (200mg/8h) for being depressed and tired. His family reported that 48h later he began with behavior disorders, reason why they took him to hospital.Upon arrival to the emergency room he showed disconnection from environment, reactive bilateral mydriasis, 39.6°C fever, sinus tachycardia (135lpm) and hypertension (185/95mmHg), as well as ocular clonus and myoclonus movement in lower extremities, along with hyperreflexia without muscle hypertonia. No analytical or radiological disorder was found that justified the symptomatology. He was admitted to the ICU for monitoring, and 24h after linezolid and 5-hydroxytryptophan withdrawal, symptoms disappeared. Linezolid was reintroduced again two days later, due to microbiological finding of methicillin-resistant Staphylococcus aureus in the culture of the ulcer, good sensitivity to that antibiotic and patient preference for oral antibiotics, to let him go home early. Symptomatology did no reappear.Serotonergic syndrome is a potentially lethal adverse reaction characterized by the appearance of altered mental state, autonomic dysfunction and alterations neuromuscular disorders.<a class="elsevierStyleCrossRefs" href="#bib0055">1,2</a> The diagnosis is clinical.Drugs<a class="elsevierStyleCrossRefs" href="#bib0065">3–6</a> associated are reflected in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. Moreover, l-tryptophan and its derivative, 5-hydroxytryptophan, are essential amino acids widely used in the alternative medicine to treat different conditions, such as depression, for being serotonin precursors. Therefore, in our case it exercised an adjuvant role with linezolid (MAO inhibitor) regarding serotonergic hyperactivity condition.<a class="elsevierStyleCrossRefs" href="#bib0085">7–9</a> Our patient, on the other hand, received linezolid, first intravenously and then orally. Afterwards, he restarted treatment without recurrence of symptoms, which enhances the significance 5-hydroxytryptophan had in this case in the serotonergic condition, as well as in its disappearance within 24h after withdrawal. We can state, therefore, that the Karch and Lasagna causality algorithm was met,<a class="elsevierStyleCrossRef" href="#bib0100">10</a> in terms of reasonable time sequence between the introduction of 5-hydroxytryptophan and the occurrence of the symptomatology, foreknowledge of the reaction, disappearance of symptoms after discontinuation and nonexistence of alternative explanations.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>We think that this case should alert about the potential adverse effects alternative medicine may have when used out of control. In addition, the physician should ask the patients directly, before prescribing a drug, if they are taking any product from the pharmacopeia of alternative medicine. Likewise, there are other types of patients,<a class="elsevierStyleCrossRefs" href="#bib0075">5,6</a> such as psychiatric, Parkinson's and those patients being treated with morphine, particularly tramadol or dextromethorphan,<a class="elsevierStyleCrossRefs" href="#bib0055">1–5</a> in which the use of antibiotics such as linezolid should also be considered. Moreover, there are departments such as ICU or Internal Medicine and Oncology, in which the use of linezolid and other drugs such as opiates are standard practice. Therefore, sometimes it is difficult to unmask a serotonergic syndrome, especially in ICUs,<a class="elsevierStyleCrossRef" href="#bib0080">6</a> as these patients, due to their severity, have tachycardia, fever, acute confusional state and sometimes they are under sedation and/or intubation, reason why neuromuscular disorders are not detected. All this should make us think about possible drug interactions before prescribing any treatment, especially in polypharmacy patients.<a class="elsevierStyleCrossRefs" href="#bib0075">5,6</a> We report our case to pharmacovigilance." "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Ostabal Artigas MI. Síndrome serotoninérgico por interacción entre linezolid y 5-hidroxitriptófano. Med Clin (Barc). 2015;145:e37–e38." ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Metoclopramide \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">First-generation antihistamines \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Tricyclic antidepressants (TCAs) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Selective serotonin reuptake inhibitors (sertraline, fluoxetine, venlafaxine) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Selective serotonin and noradrenaline reuptake inhibitors \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Opioids (tramadol, pethidine, dextromethorphan) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sumatriptan and other triptans \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Valproate \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Lithium \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Amphetamines, LSD, ecstasy \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Plant extracts (ginseng, St. John's wort) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Carbidopa \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Linezolid \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1042232.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Drugs associated with serotonergic syndrome." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The serotonin syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "E.W. Boyer" 1 => "M. Shannon" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMra041867" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2005" "volumen" => "352" "paginaInicial" => "1112" "paginaFinal" => "1120" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15784664" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0060" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Serotonin syndrome after concomitant treatment with linezolid and meperidine" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "P.K. Das" 1 => "D.I. Warketin" 2 => "R. Hewko" 3 => "D.L. Forrest" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1086/524671" "Revista" => array:6 [ "tituloSerie" => "Clin Infect Dis" "fecha" => "2008" "volumen" => "46" "paginaInicial" => "264" "paginaFinal" => "265" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18171260" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0065" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Serotonin syndrome associated with linezolid treatment after discontinuation of fluoxetine" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "N. Morales" 1 => "H. Vermette" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1176/appi.psy.46.3.274" "Revista" => array:6 [ "tituloSerie" => "Psychosomatics" "fecha" => "2005" "volumen" => "46" "paginaInicial" => "274" "paginaFinal" => "275" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15883150" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0070" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Síndrome serotoninérgico desencadenado por linezolid" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "E. Hernández-Lorente" 1 => "P. Lalueza Broto" 2 => "L. Girona Brumós" 3 => "C.P. Simeón Aznar" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Med Clin (Barc)" "fecha" => "2009" "volumen" => "132" "paginaInicial" => "157" "paginaFinal" => "158" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0075" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Interacciones farmacológicas: escala de probabilidad de Horn" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.C. Juárez-Giménez" 1 => "P. Lalueza-Broto" 2 => "L. Girona-Brumos" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Med Clin (Barc)" "fecha" => "2008" "volumen" => "130" "paginaInicial" => "119" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0080" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "El síndrome serotoninérgico y su importancia en el diagnóstico diferencial en los pacientes polimedicados" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "A. Herrán" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Emergencias" "fecha" => "1998" "volumen" => "10" "paginaInicial" => "265" "paginaFinal" => "270" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0085" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Síndrome serotoninérgico por interacción entre linezolid, triptófano y metoclopramida" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A. Colomar Ferrá" 1 => "P. Ventayol Bosch" 2 => "J.M. Raurich" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.medin.2009.01.001" "Revista" => array:6 [ "tituloSerie" => "Med Intensiva" "fecha" => "2009" "volumen" => "33" "paginaInicial" => "360" "paginaFinal" => "361" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19828401" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0090" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Serotonergic and adrenergic drug interactions associated with linezolid: a critical review and practical management approach" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "T.D. Ramsey" 1 => "T.T. Lau" 2 => "M.H. Ensom" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1345/aph.1R604" "Revista" => array:6 [ "tituloSerie" => "Ann Pharmacother" "fecha" => "2013" "volumen" => "47" "paginaInicial" => "543" "paginaFinal" => "560" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23548646" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0095" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Probable serotonin syndrome due to linezolid and meperidine interaction" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J.J. Elizondo Armendáriz" 1 => "E. Pellejero Hernando" 2 => "M.M. Noceda Urarte" 3 => "M. Gutiérrez Valencia" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.farma.2011.10.006" "Revista" => array:6 [ "tituloSerie" => "Farm Hosp" "fecha" => "2012" "volumen" => "36" "paginaInicial" => "448" "paginaFinal" => "449" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22440516" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0100" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Toward the operational identification of adverse drug reactions" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "F.E. Karch" 1 => "L. 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ISSN: 2387-0206

Launched in 1943, Medicina Clínica is a fortnightly journal aimed at the promotion of clinical research and practice among internal medicine and other specialists. The key characteristics of Medicina Clínica are the scientific and methodological rigor of its manuscripts, the topicality of its contents, and, especially, its practical focus with highly useful information for clinical practice. Medicina Clínica is predominantly interested in publishing original research manuscripts, which are rigorously selected according to their quality, originality, and interest, and also in continued medical education-oriented manuscripts, which are commissioned by the journal to relevant authors (Editorials, Reviews, and Diagnosis and Treatment). These manuscripts contain updated topics with a major clinical or conceptual relevance in modern medicine. The journal adheres to the standards of academic research publications in all aspects including peer-review and ethical principles. Medicina Clínica is included in the General and Internal Medicine category of Thomson Reuters.

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Current Contents/Clinical Medicine, Journal Citation Reports, SCI-Expanded, Index Medicus/Medline, Excerpta Medica/EMBASE, IBECS, IME, MEDES, PASCAL, SCOPUS, SciVerse ScienceDirect

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Impact factor

The Impact Factor measures the average number of citations received in a particular year by papers published in the journal during the two preceding years.

© Clarivate Analytics, Journal Citation Reports 2022

Impact factor 2023

2.6

Citescore

CiteScore measures average citations received per document published.

Citescore 2023

3.1

SJR

SRJ is a prestige metric based on the idea that not all citations are the same. SJR uses a similar algorithm as the Google page rank; it provides a quantitative and qualitative measure of the journal's impact.

SJR 2023

0.371

SNIP

SNIP measures contextual citation impact by wighting citations based on the total number of citations in a subject field.

SNIP 2023

0.511

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Journal Information

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Vol. 145. Issue 12.