Page 107 - JCBP-3-1

Journal of Clinical and
Basic Psychosomatics Serotonin syndrome unexpected medication

instability. His rapid onset of symptoms after initiating and potential future directions. Int J Tryptophan Res.
metaxalone with concomitant phentermine use suggests a 2019;12:117864691987392.
direct link to serotonin syndrome. After discontinuation of doi: 10.1177/1178646919873925
all serotonergic agents and the provision of supportive care,
the patient still experienced altered mental status, autonomic 2. Talton CW. Serotonin syndrome/serotonin toxicity. Fed
Pract. 2020;37(10):452-459.
instability, and muscle rigidity, requiring lorazepam and
cyproheptadine administration. Consequently, the patient doi: 10.12788/fp.0042
returned to his clinical baseline within 24 h. 3. Dunkley EJC, Isbister GK, Sibbritt D, Dawson AH,
Whyte IM. The hunter serotonin toxicity criteria: Simple
4. Conclusion and accurate diagnostic decision rules for serotonin toxicity.
This case highlights the importance of monitoring QJM. 2003;96(9):635-642.
for serotonin syndrome in patients receiving multiple doi: 10.1093/qjmed/hcg109
serotonergic medications, including metaxalone, which 4. Huecker MR, Smiley A, Saadabadi A. Bupropion. In:
is not commonly linked to this condition. Health-care StatPearls. Available from: https://www.ncbi.nlm.nih.gov/
providers should maintain a high index of suspicion for pubmed/9554319 [Last accessed on 2024 Jul 22].
this condition, especially when prescribing combinations 5. Bosak AR, Skolnik AB. Serotonin syndrome associated with
of serotonergic medications. Additional research is metaxalone overdose. J Med Toxicol. 2014;10(4):402-405.
warranted to better understand the serotonergic properties
of metaxalone and similar drugs to enhance patient safety doi: 10.1007/s13181-014-0404-5
in the context of polypharmacy. 6. Martini DI, Nacca N, Haswell D, Cobb T, Hodgman M.
Serotonin syndrome following metaxalone overdose and
Acknowledgments therapeutic use of a selective serotonin reuptake inhibitor.

None. Clin Toxicol. 2015;53(3):185-187.
doi: 10.3109/15563650.2015.1009993
Funding
7. Surmaitis RM, Nappe TM, Cook MD. Serotonin syndrome
None. associated with therapeutic metaxalone in a patient with
cirrhosis. Am J Emerg Med. 2016;34(2):346.e5-e6.
Conflict of interest doi: 10.1016/j.ajem.2015.06.043

The authors declare that they have no competing interests. 8. Suissa K, Schneeweiss S, Kim DW, Patorno E. Prescribing
trends and clinical characteristics of patients starting
Author contributions antiobesity drugs in the United States. Diabetes Obes Metab.
Conceptualization: All authors 2021;23(7):1542-1551.
Investigation: All authors doi: 10.1111/dom.14367
Writing – original draft: All authors 9. Ulus IH, Maher TJ, Wurtman RJ. Characterization of
Writing – review & editing: All authors
phentermine and related compounds as monoamine oxidase
Ethics approval and consent to participate (MAO) inhibitors. Biochem Pharmacol. 2000;59(12):1611-1621.
doi: 10.1016/s0006-2952(00)00306-3
Verbal and written consent was obtained from the patient
before participation 10. Westanmo AD, Gayken J, Haight R. Duloxetine: A balanced
and selective norepinephrine- and serotonin-reuptake
Consent for publication inhibitor. Am J Health Syst Pharm. 2005;62(23):2481-2490.
The patient gave consent to publish his data in this study. doi: 10.2146/ajhp050006
11. Foley KF, DeSanty KP, Kast RE. Bupropion: Pharmacology
Availability of data and therapeutic applications. Expert Rev Neurother.
Data are available from the corresponding author upon 2006;6(9):1249-1265.
reasonable request. doi: 10.1586/14737175.6.9.1249
References 12. Perez CI, Kalyanasundar B, Moreno MG, Gutierrez R. The
triple combination phentermine plus 5-HTP/carbidopa
1. Scotton WJ, Hill LJ, Williams AC, Barnes NM. Serotonin leads to greater weight loss, with fewer psychomotor side
syndrome: Pathophysiology, clinical features, management, effects than each drug alone. Front Pharmacol. 2019;10:1327.

Volume 3 Issue 1 (2025) 101 doi: 10.36922/jcbp.4490