James A. Haley Veterans' Hospital, Mental Health and Behavioral Sciences Service, University of South Florida, Psychiatry and Behavioral Neurosciences, Tampa, FL.
James A. Haley Veterans' Hospital, Mental Health and Behavioral Sciences Service, University of South Florida, Psychiatry and Behavioral Neurosciences, Tampa, FL.
Psychosomatics. 2018 Nov;59(6):539-546. doi: 10.1016/j.psym.2018.06.012. Epub 2018 Jul 3.
Serotonin syndrome (SS) is a potentially serious side effect of serotonergic drugs. Cases of SS have been reported from the administration of methylene blue (MB), an agent with monoamine oxidase inhibiting properties. To date, the reported cases of MB-induced SS have all been with MB given parenterally. We report a case induced by the initiation of a MB-containing oral agent.
A case of SS felt to be induced by the initiation of an MB-containing orally-administered urinary analgesic, started in a patient concurrently treated with multiple serotonergic drugs, is presented. A systematic literature review of MB-induced SS follows. The review consisted of searches in MEDLINE databases using the key terms "methylene blue" and "serotonin syndrome". The authors read all abstracts, and articles related to MB and serotonin toxicity; non-associated articles were discarded. Results are summarized.
23 manuscripts were identified, resulting in 50 unique cases of MB-induced SS. The majority of cases were related to peri-operative use of MB in parathyroidectomies or for the treatment of vasoplegic shock. All cases were associated with MB given parenterally. Concurrent treatment with serotonergic antidepressants was described in all 50 cases. Symptoms of SS ranged from mild to severe. One fatality was reported.
Methylene blue can induce SS, felt to be secondary to MAOI properties. Although previous reports have exclusively been associated with MB given via parental administration, our case suggests that SS can be induced by oral administration of MB-containing agents.
血清素综合征（SS）是一种潜在的严重的血清素能药物的副作用。已有报道称，使用具有单胺氧化酶抑制作用的亚甲蓝（MB）会导致 SS。迄今为止，报道的 MB 诱导的 SS 病例均为静脉注射 MB 所致。我们报告了一例由含 MB 的口服药物引起的 SS 病例。
我们报告了一例 SS 病例，认为是由同时接受多种血清素能药物治疗的患者开始服用含 MB 的口服尿路镇痛药引起的。对 MB 诱导的 SS 进行了系统的文献回顾。该综述在 MEDLINE 数据库中使用“methylene blue”和“serotonin syndrome”这两个关键词进行了搜索。作者阅读了所有摘要和与 MB 及血清素毒性相关的文章；非相关文章被丢弃。结果进行了总结。
共确定了 23 篇文献，导致了 50 例独特的 MB 诱导的 SS 病例。大多数病例与围手术期使用 MB 治疗甲状旁腺切除术或血管扩张性休克有关。所有病例均与静脉注射 MB 有关。50 例均描述了同时使用血清素能抗抑郁药。SS 的症状从轻度到重度不等。报告了 1 例死亡。
亚甲蓝可引起 SS，认为是由于 MAOI 特性所致。尽管以前的报告仅与静脉注射 MB 有关，但我们的病例表明，含 MB 的口服药物也可引起 SS。
