Pharmacy Practice, MCPHS University, Boston, MA, USA.
Private Practice, Reading, MA, USA.
J Pharm Pract. 2020 Apr;33(2):206-212. doi: 10.1177/0897190019841742. Epub 2019 Apr 28.
Paroxetine is a selective serotonin reuptake inhibitor (SSRI) with several indications, one of which is for depression. We present a case of probable paroxetine-induced serotonin syndrome.
A 21-year-old female with a history of generalized anxiety disorder and major depression presented with increased depressive symptoms over several months while taking fluoxetine 20 mg daily. Fluoxetine was discontinued without taper and replaced with paroxetine 10 mg daily, along with hydroxyzine 50 mg twice daily as needed for anxiety. Within a week of starting the paroxetine, the patient reported increased anxiety, insomnia, and constant shaking. The paroxetine continued to be uptitrated over a 3-week period to a dose 30 mg due to unremitting depressive symptoms. One month later, the patient presented with tachycardia, generalized body aches, extreme fatigue, weakness, uncontrollable twitching, tremor, and hyperreflexia. A widespread burning sensation accompanied by random hot flashes without diaphoresis was also noted. Serotonin syndrome was diagnosed using the Hunters criteria. Paroxetine was discontinued, and the patient's physical symptoms resolved within a week.
To date, only 5 cases of serotonin syndrome have been reported in patients receiving SSRI monotherapy at recommended therapeutic doses.
帕罗西汀是一种选择性 5-羟色胺再摄取抑制剂（SSRI），具有多种适应证，其中之一是治疗抑郁症。我们报告了一例可能由帕罗西汀引起的 5-羟色胺综合征。
一名 21 岁女性，既往有广泛性焦虑障碍和重度抑郁症病史，在服用氟西汀 20mg/d 数月后出现抑郁症状加重。氟西汀未逐渐减量即停药，换用帕罗西汀 10mg/d，同时按需每日服用 2 次氢可酮 50mg 以缓解焦虑。在开始服用帕罗西汀的一周内，患者报告焦虑、失眠和持续震颤加重。由于持续性抑郁症状，帕罗西汀在 3 周内逐渐加量至 30mg。一个月后，患者出现心动过速、全身疼痛、极度疲劳、虚弱、无法控制的抽搐、震颤和反射亢进。还伴有广泛的烧灼感，伴有随机的潮热但无出汗。根据 Hunters 标准诊断为 5-羟色胺综合征。停用帕罗西汀后，患者的躯体症状在一周内得到缓解。
迄今为止，仅在接受推荐治疗剂量的 SSRIs 单药治疗的患者中报告了 5 例 5-羟色胺综合征。
