Reactions 1000 - 8 May 2004

SCitalopram/clonazepam/trazodone

Serotonin syndrome and dysphagia in an elderlypatient: case report

A 74-year-old woman developed serotonin syndrome withprolonged dysphagia during treatment with citalopram,clonazepam and trazodone for a major depressive disorder.

The woman had taken citalopram 40 mg/day andclonazepam 4 mg/day for 6 months and was also takingtrazodone 50 mg/day [duration of therapy not stated]. Hertrazodone dosage was then increased to 100 mg/day and,48 hours later, she was hospitalised with acute-onset agitation,tremor, hyper-reflexia, myoclonus, ataxia, mutism anddifficulty swallowing. Serotonin syndrome was diagnosed.

Citalopram, clonazepam and trazodone were discontinuedand the woman was treated with supportive therapy includinglorazepam to prevent benzodiazepine withdrawal, IVhydration and nasogastric feeding. On hospital day 6, herneurological symptoms were resolving, however dysphagiapersisted. Swallowing assessment revealed lingual tremor,poor tongue extrusion, a mild reflex trigger delay and mouthbreathing during swallowing. A trial of thick liquids resulted incoughing and distress, so her diet was restricted to gels. Herneurological symptoms completely resolved, but shecontinued to experience marked dysphagia for 25 days afteradmission. She was subsequently able to gradually tolerate areturn to normal diet.

Author comment: "In this patient, we observed SS[serotonin syndrome] with the combination of trazodone,citalopram, and clonazepam, all of which have serotonergicproperties and no major mutual pharmacokineticinteractions. . . In patients with SS, serotonergic hyperactivityat the NTS [nucleus tractus solitarius] may . . . inhibit theswallowing reflex. We hope to inform clinicians of thepotential for dysphagia in SS and we encourage monitoringfor complications such as aspiration pneumonia during therecovery phase."Passmore MJ, et al. Serotonin syndrome with prolonged dysphagia. CanadianJournal of Psychiatry 49: 79-80, No. 1, Jan 2004 - Canada 800972677

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Reactions 8 May 2004 No. 10000114-9954/10/1000-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved