Suboxone (buprenorphine/naloxone) is an oral medication used for the treatment of
opiate dependence. Because of its mixed properties at the opiate receptors, buprenorphine
has a ceiling on its euphoric effects. We report the first case of serotonin syndrome
caused by buprenorphine and review other medications implicated in serotonin syndrome.
A 54-year-old man on tricyclic antidepressants took an unprescribed dose of buprenorphine/naloxone.
He presented to the emergency department with signs and symptoms of severe serotonin
syndrome including clonus, agitation, and altered mental status. His agitation was
not controlled with benzodiazepines and was electively intubated. At the recommendation
of the toxicology service, cyproheptadine, a serotonin receptor antagonist, was administered
with improvement in the patient's symptoms. Emergency physicians should be aware of
the potential of buprenorphine/naloxone to trigger serotonin syndrome.
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http://www.fda.gov/cder/drug/infopage/subutex_suboxone [Accessed June 25, 2007].
Ibid.
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Article info
Publication history
Accepted:
January 27,
2008
Received:
December 27,
2007
Identification
Copyright
© 2008 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
