Abstract
A 52 year old woman on buspirone was prescribed paroxetine for depressive symptoms. She also got papaverine. Within a month she experienced high fever, shivering, tremor, hyper-reflexia, tachycardia (120 bpm), and tracheal cramps, symptoms of the serotonin syndrome. Since both paroxetine and buspirone have serotonergic effects it is probable that the symptoms were caused by the drug combination. She also had ecchymoses on her thighs, probably due to serotonergic effects. The symptoms rapidly decreased after withdrawing paroxetine. Paroxetine, papaverine, and possibly also buspirone interact with cytochrome P450 CYP2D6. They can probably inhibit the metabolism of each other. We recommend observance of serotonergic syndrome symptoms and restricted combination of serotoninergic drugs.
Publication types
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Case Reports
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English Abstract
MeSH terms
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Antidepressive Agents, Second-Generation / administration & dosage
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Antidepressive Agents, Second-Generation / adverse effects*
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Antidepressive Agents, Second-Generation / metabolism
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Buspirone / administration & dosage
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Buspirone / adverse effects*
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Buspirone / metabolism
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Cytochrome P-450 CYP2D6 / metabolism
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Depression / drug therapy*
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Drug Interactions
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Drug Therapy, Combination
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Female
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Humans
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Middle Aged
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Papaverine / administration & dosage*
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Papaverine / adverse effects
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Papaverine / metabolism
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Paroxetine / administration & dosage
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Paroxetine / adverse effects*
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Paroxetine / metabolism
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Selective Serotonin Reuptake Inhibitors / administration & dosage
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Selective Serotonin Reuptake Inhibitors / adverse effects*
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Selective Serotonin Reuptake Inhibitors / metabolism
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Serotonin Receptor Agonists / administration & dosage
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Serotonin Receptor Agonists / adverse effects*
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Serotonin Receptor Agonists / metabolism
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Serotonin Syndrome / chemically induced*
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Vasodilator Agents / administration & dosage
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Vasodilator Agents / adverse effects
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Vasodilator Agents / metabolism
Substances
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Antidepressive Agents, Second-Generation
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Serotonin Receptor Agonists
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Serotonin Uptake Inhibitors
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Vasodilator Agents
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Paroxetine
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Papaverine
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Cytochrome P-450 CYP2D6
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Buspirone