Steinberg Michael, Morin Anna K
Massachusetts College of Pharmacy and Health Sciences, Worcester, Massachusetts 01608, USA.
Am J Health Syst Pharm. 2007 Jan 1;64(1):59-62. doi: 10.2146/ajhp060227.
A case of serotonin syndrome that developed during concurrent linezolid and fluoxetine is presented.
A 23-year-old white male patient was originally admitted to receive intravenous chemotherapy for acute myelogenous leukemia. He had a history of intravenous amphetamine abuse, hepatitis B virus infection, hepatitis C virus infection, depression, and bipolar disorder. The patient's routine medications before admission included methadone, fluoxetine, voriconazole, transdermal nicotine patch, lorazepam, and quetiapine. The patient developed persistent neutropenia and complications from chemotherapy, including mild mucositis. Despite treatment with levofloxacin, acyclovir, and voriconazole, the patient developed high fevers. Levofloxacin was discontinued and aztreonam and vancomycin were started. After a blood culture revealed that the bacteria were likely vancomycin resistant, vancomycin was discontinued and linezolid was initiated. Nine hours later, the patient began complaining of severe pain in his abdomen. After a total of four doses of linezolid, the patient reported further discomfort. Two days after linezolid initiation, a health care team member identified the interaction between fluoxetine and linezolid as the cause of the patient's symptoms, and linezolid was discontinued. All symptoms resolved within 48 hours. While resolution generally occurs within 24-48 hours after discontinuing the offending agent, the time to resolution may be delayed if the agent has a long half-life or active metabolites, in which case admission to an intensive care unit is recommended. Cyproheptadine and chlorpromazine may also be used to treat symptoms.
Serotonin syndrome developed in a patient taking concurrent linezolid and fluoxetine.
报告1例在同时使用利奈唑胺和氟西汀期间发生的血清素综合征病例。
一名23岁白人男性患者最初因急性髓性白血病入院接受静脉化疗。他有静脉注射苯丙胺滥用史、乙型肝炎病毒感染、丙型肝炎病毒感染、抑郁症和双相情感障碍病史。患者入院前的常规用药包括美沙酮、氟西汀、伏立康唑、经皮尼古丁贴片、劳拉西泮和喹硫平。患者出现持续中性粒细胞减少及化疗相关并发症，包括轻度粘膜炎。尽管使用左氧氟沙星、阿昔洛韦和伏立康唑治疗，患者仍出现高热。停用左氧氟沙星，开始使用氨曲南和万古霉素。血培养显示细菌可能对万古霉素耐药后，停用万古霉素并开始使用利奈唑胺。9小时后，患者开始诉说腹部剧痛。在总共使用4剂利奈唑胺后，患者报告有进一步不适。开始使用利奈唑胺2天后，一名医护人员确定氟西汀与利奈唑胺之间的相互作用是患者症状的原因，遂停用利奈唑胺。所有症状在48小时内缓解。虽然一般在停用致病药物后24 - 48小时内症状会缓解，但如果该药物半衰期长或有活性代谢产物，缓解时间可能会延迟，在这种情况下建议收入重症监护病房。赛庚啶和氯丙嗪也可用于治疗症状。
1例同时服用利奈唑胺和氟西汀的患者发生了血清素综合征。
