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].
- 2005 Annual Report of the American Association of Poison Control Centers' national poisoning and exposure database.Clin Toxicol. 2006; 44: 803-932
- The serotonin syndrome scale: first results on validity.Eur Arch Psychiatry Clin Neurosci. 1998; 248: 96-103
- The serotonin syndrome: investigation using the Japanese version of the Serotonin Syndrome Scale.Psychiatry Res. 2001; 105: 135-142
- The serotonin syndrome.N Engl J Med. 2005; 352: 1112-1120
- A case of serotonin syndrome and mutism associated with methadone.J Palliat Med. 2006; 9: 1257-1259
- Serotonin syndrome associated with tramadol-sertraline co-administration.Clin Neuropharmacol. 2004; 27: 150-151
- Serotonin syndrome induced by amitriptyline, meperidine, and venlafaxine.Ann Pharmacother. 2002; 36: 1647-1648
- Serotonin syndrome resulting from co-administration of tramadol, venlafaxine, and mirtazapine.Ann Pharmacother. 2004; 38: 411-413
- Tramadol and severe serotonin syndrome.Anaesthesia. 2005; 60: 934-935
- Monoamine oxidase inhibitors, opioid analgesics and serotonin toxicity.Br J Anaesth. 2005; 95: 434-441
- Serotonin syndrome induced by fluvoxamine and oxycodone.Ann Pharmacother. 2006; 40: 155-157
- Visual hallucination and tremor induced by sertraline and oxycodone in a bone marrow transplant patient.J Clin Pharmacol. 2001; 41: 224-227
- Interaction of serotonergic antidepressants and opioid analgesics: is serotonin syndrome going undetected?.J Am Med Dir Assoc. 2005; 6: 265-269
- Analgesic and narcotic antagonist effects of buprenorphine (author's translation).Nippon Yakurigaku Zasshi. 1982; 79: 147-162
- Alteration in regulation of serotonin release in rat dorsal raphe nucleus after prolonged exposure to morphine.J Pharmacol Exp Ther. 1998; 286: 481-488
- Opioids suppress spontaneous and NMDA-induced inhibitory postsynaptic currents in the dorsal raphe nucleus of the rat in vitro.Brain Res. 1997; 755: 229-245
Accepted: January 27, 2008
Received: December 27, 2007
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