Combination of Escitalopram and Rasagiline Induced Serotonin Syndrome: A Case Report and Review Literature

Juthathip Suphanklang PharmD*, Wichai Santimaleeworagun PhD*, Ouppatham Supasyndh MD**

Affiliation : * Department of Pharmacy, Faculty of Pharmacy, Silpakorn University, Nakornpathom, Thailand ** Division of Nephrology, Department of Internal Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand

Background : Serotonin syndrome is a rare but potentially fatal complication of drugs that have effects on central nervous system serotonin. It is characterized by sudden onset of altered mental status, increased neuromuscular activity, and autonomic instability.
Case Report : The authors reported a case of serotonin syndrome associated with combined therapy of monoamine oxidase-B inhibitors and selective serotonin reuptake inhibitor. A 77-year-old Thai man had been taking escitalopram for depression for three years. He presented with high-grade fever and confusion two days after taking rasagiline for Parkinson’s disease. He also had agitation, hallucination, and behavioral change. Escitalopram and rasagiline were discontinued but his renal function worsened, turning to acute kidney injury. He was diagnosed as serotonin syndrome.
Conclusion : This is the first case report of serotonin syndrome due to combination of escitalopram and rasagiline used.

Keywords : Escitalopram, Rasagiline, Serotonin syndrome

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