Letter to the Editor
Serotoninergic syndrome due to interaction between linezolid and 5-hydroxytryptophan
Síndrome serotoninérgico por interacción entre linezolid y 5-hidroxitriptófano
María Isabel Ostabal Artigas
Unidad de Cuidados Intensivos Polivalente, Hospital Miguel Servet, Zaragoza, Spain
Read
Not available
Timeswas read the article
Total PDF
Total HTML
Share statistics
array:24 [ "pii" => "S2387020616300523" "issn" => "23870206" "doi" => "10.1016/j.medcle.2016.04.030" "estado" => "S300" "fechaPublicacion" => "2015-12-21" "aid" => "3284" "copyright" => "Elsevier España, S.L.U.. All rights reserved" "copyrightAnyo" => "2015" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Clin. 2015;145:e37-8" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0025775315001906" "issn" => "00257753" "doi" => "10.1016/j.medcli.2015.03.010" "estado" => "S300" "fechaPublicacion" => "2015-12-21" "aid" => "3284" "copyright" => "Elsevier España, S.L.U." "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Clin. 2015;145:e37-8" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 580 "formatos" => array:2 [ "HTML" => 12 "PDF" => 568 ] ] "es" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta al Editor</span>" "titulo" => "Síndrome serotoninérgico por interacción entre linezolid y 5-hidroxitriptófano" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "e37" "paginaFinal" => "e38" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Serotoninergic syndrome due to interaction between linezolid and 5-hydroxytryptophan" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "María Isabel Ostabal Artigas" "autores" => array:1 [ 0 => array:2 [ "nombre" => "María Isabel" "apellidos" => "Ostabal Artigas" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2387020616300523" "doi" => "10.1016/j.medcle.2016.04.030" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020616300523?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775315001906?idApp=UINPBA00004N" "url" => "/00257753/0000014500000012/v1_201512060029/S0025775315001906/v1_201512060029/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2387020616300535" "issn" => "23870206" "doi" => "10.1016/j.medcle.2016.04.031" "estado" => "S300" "fechaPublicacion" => "2015-12-21" "aid" => "3287" "copyright" => "Elsevier España, S.L.U." "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Clin. 2015;145:e39-40" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Atypical presentation and delayed diagnosis in a case of primary bile acid synthesis disorder" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "e39" "paginaFinal" => "e40" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Presentación atípica y diagnóstico tardío en un caso de déficit primario de ácidos biliares" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Cristina Garfia Castillo, Javier Manzanares López-Manzanares, M. Teresa García Silva" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Cristina" "apellidos" => "Garfia Castillo" ] 1 => array:2 [ "nombre" => "Javier" "apellidos" => "Manzanares López-Manzanares" ] 2 => array:2 [ "nombre" => "M. Teresa" "apellidos" => "García Silva" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0025775315002134" "doi" => "10.1016/j.medcli.2015.04.002" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775315002134?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020616300535?idApp=UINPBA00004N" "url" => "/23870206/0000014500000012/v1_201605120032/S2387020616300535/v1_201605120032/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S238702061630050X" "issn" => "23870206" "doi" => "10.1016/j.medcle.2016.04.028" "estado" => "S300" "fechaPublicacion" => "2015-12-21" "aid" => "3271" "copyright" => "Elsevier España, S.L.U." "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Clin. 2015;145:554-5" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Treatment of perioperative anemia in hip fracture" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "554" "paginaFinal" => "555" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Tratamiento de la anemia perioperatoria de la fractura de cadera" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "José Antonio García Erce, Susana Gómez Ramírez, Jorge Cuenca Espiérrez, Manuel Muñoz Gómez" "autores" => array:4 [ 0 => array:2 [ "nombre" => "José Antonio" "apellidos" => "García Erce" ] 1 => array:2 [ "nombre" => "Susana" "apellidos" => "Gómez Ramírez" ] 2 => array:2 [ "nombre" => "Jorge" "apellidos" => "Cuenca Espiérrez" ] 3 => array:2 [ "nombre" => "Manuel" "apellidos" => "Muñoz Gómez" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0025775315001463" "doi" => "10.1016/j.medcli.2015.02.021" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775315001463?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S238702061630050X?idApp=UINPBA00004N" "url" => "/23870206/0000014500000012/v1_201605120032/S238702061630050X/v1_201605120032/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Serotoninergic syndrome due to interaction between linezolid and 5-hydroxytryptophan" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "e37" "paginaFinal" => "e38" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "María Isabel Ostabal Artigas" "autores" => array:1 [ 0 => array:3 [ "nombre" => "María Isabel" "apellidos" => "Ostabal Artigas" "email" => array:1 [ 0 => "isabelostabal1@gmail.com" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Unidad de Cuidados Intensivos Polivalente, Hospital Miguel Servet, Zaragoza, Spain" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Síndrome serotoninérgico por interacción entre linezolid y 5-hidroxitriptófano" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Traditional medicine often overlaps with alternative medicine. 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<span class="elsevierStyleSup">®</span> 5-HTP) on his own, acquired by Internet, for depressive symptoms.</p><p id="par0010" class="elsevierStylePara elsevierViewall">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 (600<span class="elsevierStyleHsp" style=""></span>mg/12<span class="elsevierStyleHsp" style=""></span>h) 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 (600<span class="elsevierStyleHsp" style=""></span>mg/12<span class="elsevierStyleHsp" style=""></span>h) and ambulatory cures. Upon arrival home he began taking 5-hydroxytryptophan supplements (200<span class="elsevierStyleHsp" style=""></span>mg/8<span class="elsevierStyleHsp" style=""></span>h) for being depressed and tired. His family reported that 48<span class="elsevierStyleHsp" style=""></span>h later he began with behavior disorders, reason why they took him to hospital.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Upon arrival to the emergency room he showed disconnection from environment, reactive bilateral mydriasis, 39.6<span class="elsevierStyleHsp" style=""></span>°C fever, sinus tachycardia (135<span class="elsevierStyleHsp" style=""></span>lpm) and hypertension (185/95<span class="elsevierStyleHsp" style=""></span>mmHg), 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 24<span class="elsevierStyleHsp" style=""></span>h after linezolid and 5-hydroxytryptophan withdrawal, symptoms disappeared. Linezolid was reintroduced again two days later, due to microbiological finding of methicillin-resistant <span class="elsevierStyleItalic">Staphylococcus aureus</span> 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.</p><p id="par0020" class="elsevierStylePara elsevierViewall">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"><span class="elsevierStyleSup">1,2</span></a> The diagnosis is clinical.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Drugs<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3–6</span></a> associated are reflected in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. Moreover, <span class="elsevierStyleSmallCaps">l</span>-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"><span class="elsevierStyleSup">7–9</span></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 24<span class="elsevierStyleHsp" style=""></span>h after withdrawal. We can state, therefore, that the Karch and Lasagna causality algorithm was met,<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></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.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">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"><span class="elsevierStyleSup">5,6</span></a> such as psychiatric, Parkinson's and those patients being treated with morphine, particularly tramadol or dextromethorphan,<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1–5</span></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"><span class="elsevierStyleSup">6</span></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"><span class="elsevierStyleSup">5,6</span></a> We report our case to pharmacovigilance.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Ostabal Artigas MI. Síndrome serotoninérgico por interacción entre linezolid y 5-hidroxitriptófano. Med Clin (Barc). 2015;145:e37–e38.</p>" ] ] "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" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Drugs associated with serotonergic syndrome.</p>" ] ] ] "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. Lasagna" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Clin Pharmacol Ther" "fecha" => "1977" "volumen" => "21" "paginaInicial" => "247" "paginaFinal" => "254" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/837643" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000014500000012/v1_201605120032/S2387020616300523/v1_201605120032/en/main.assets" "Apartado" => array:4 [ "identificador" => "43309" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000014500000012/v1_201605120032/S2387020616300523/v1_201605120032/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020616300523?idApp=UINPBA00004N" ]
