The present paper describes a case of serious toxicity in a patient taking excessive doses of a new MAO inhibitor, tranylcypromine (Parnate), and imipramine. Preliminary toxicity data in rats support clinical observation in this case of [jamanetwork.com]

Snapshot A patient presents to your office for follow-up for treatment of depression. He just emigrated from Chile where he was treated by a psychiatrist for his depression. A few weeks ago, he attended a holiday party with his family. [step2.medbullets.com]

MAOI toxicity can present with diaphoresis whereas an anticholinergic syndrome should have dry skin. Additionally, MAOI toxicity is much more likely to present with generalized or ocular clonus than neuroleptic malignant syndrome. [ncbi.nlm.nih.gov]

Serotonin syndrome in the intensive care unit: clinical presentations and precipitating medications. Neurocrit Care. 2014;21:108-137. Stanford SC, Stanford BJ, Gillman PK. [apsf.org]

Death may result from hyperthermia which may peak as late as 24 hours after presentation. [inchem.org]

• Hyperthermia

  Death may result from hyperthermia which may peak as late as 24 hours after presentation. [inchem.org]

  Signs of moderate disease include altered mental status, tachypnea, vomiting, dysrhythmias, hyperthermia, and hypertension. [ncbi.nlm.nih.gov]

  Or… Lorazepam 0.1mg/kg max 4mg Diazepam 0.15mg/kg max 10mg Midazolam 0.2mg/kg max 10mg Hyperthermia (>39.5 degrees centigrade): This is a feature of severe toxicity and needs immediate control to prevent multi organ failure. [lifeinthefastlane.com]

  […] normally degrades tyramine, but when inhibited is fully absorbed and displaces catecholamines other sympathomimetics CNS stimulation contraindicated with other 5-HT altering drugs (SSRIs and SNRIs) or meperidine to prevent serotonin syndrome myoclonus, hyperthermia [step2.medbullets.com]

• Fatigue

  Bothersome Side Effects agitation - extreme constipation diarrhea dizziness dry mouth fatigue flushed face headache low blood pressure when standing mood swings muscle pains nausea sexual dysfunction sleeping problems stomach pain water accumulation weight [health.howstuffworks.com]

  Other side effects include fatigue, dizziness, head ache, dry mouth, and dry eyes. Children may actual become hyperexcitable rather than drowsy. Elderly are at greater risk for dizziness. [mnpoison.org]

• Nausea

  Possible symptoms include nausea and less commonly seizures and cardiac dysrhythmias. Children and young people should also be assessed for serotonin syndrome. [rch.org.au]

  Expectorants Example : Guaifenesin Purpose : Breaks up mucus to aid in coughing it up Side Effects : It is well tolerated, but some people may experience nausea, diarrhea, dizziness, headache, and drowsiness. [mnpoison.org]

  Bothersome Side Effects agitation - extreme constipation diarrhea dizziness dry mouth fatigue flushed face headache low blood pressure when standing mood swings muscle pains nausea sexual dysfunction sleeping problems stomach pain water accumulation weight [health.howstuffworks.com]

  The early symptoms of SS are nausea, vomiting, diarrhea, sweating, agitation, confusion, muscle rigidity, dilated pupils, shivers, and goose bumps. [poison.org]

  Life threatening serotonin toxicity: Requires paralysis, intubation and ventilation to prevent multi organ failure Risk Assessment Moclobemide: Minor symptoms only irrespective of dose (nausea, anxiety and tachycardia). [lifeinthefastlane.com]

• Myoclonus

  All phenylpiperidine opioids (meperidine, methadone, tramadol) are weak serotonin reuptake inhibitors and can lead to serotonin syndrome (confusion, fever, diaphoresis, shivering, ataxia, myoclonus, hyperreflexia, and death) caused by excessive serotonergic [openanesthesia.org]

  […] cheese MAO normally degrades tyramine, but when inhibited is fully absorbed and displaces catecholamines other sympathomimetics CNS stimulation contraindicated with other 5-HT altering drugs (SSRIs and SNRIs) or meperidine to prevent serotonin syndrome myoclonus [step2.medbullets.com]

  Severe signs include severe hyperthermia, seizures, central nervous system (CNS) depression, coma, cardiorespiratory depression, muscle rigidity and myoclonus. [ncbi.nlm.nih.gov]

  […] and more specific. 4 The Hunter criteria can be grouped into a triad of clinical features: Neuromuscular effects Autonomic effects Mental state changes Hyperreflexia Tachycardia Agitation Clonus (spontaneous or inducible) Hyperthermia (mild Hypomania Myoclonus [medsafe.govt.nz]

  Reproduced with permission. 3 Clinical features of serotonin toxicity Neuromuscular effects Autonomic effects Mental state changes Hyperreflexia Clonus Myoclonus Shivering Tremor Hypertonia/rigidity Hyperthermia: mild, ° C; severe ≥ 38.5 ° C Tachycardia [mja.com.au]

• Sexual Dysfunction

  Bothersome Side Effects agitation - extreme constipation diarrhea dizziness dry mouth fatigue flushed face headache low blood pressure when standing mood swings muscle pains nausea sexual dysfunction sleeping problems stomach pain water accumulation weight [health.howstuffworks.com]

  The most common side effects of SSRIs are nausea, vomiting, diarrhea, dry mouth, jitteriness, drowsiness, weight gain, weight loss, decreased sexual desire, and sexual dysfunction. [poison.org]

The long-term treatment of social phobia with moclobemide. Int Clin Psychopharmacol. 1996 ; 11 ( suppl 3 ): 83 – 88. 7. Cole, JO, Bodkin, JA. MAO inhibitors: an option worth trying in treatment-resistant cases. [cambridge.org]

Upon reviewing his medications the physician decides to start the patient on a more appropriate first-line treatment for his depression - an SSRI. [step2.medbullets.com]

Antipyretics likely will not be adequate treatment. Patients may present hypertensive, but treatment specifically for hypertension is usually not necessary. [ncbi.nlm.nih.gov]

The patient may deteriorate to multiorgan failure and death without treatment. Recommended treatment is generally supportive. [medsafe.govt.nz]

More than 300 well-organized chapters written by eminent authorities guide clinicians through the diagnosis and treatment of every poisoning or drug overdose. [books.google.de]

If end-organ damage such as myocardial infarction or CVA is prevented, prognosis for full recovery to premorbid status is excellent. The most common catastrophic com... Carr BC. [5minuteconsult.com]

[…] abused by patients having a history of prior substance abuse (Livingston & Livingston, 1996). 9.2.2 Inhalation Not relevant 9.2.3 Skin exposure Not relevant 9.2.4 Eye contact Not relevant 9.2.5 Parenteral exposure No data 9.2.6 Other No data 9.3 Course, prognosis [inchem.org]

Etiology There are three ways in which MAOI toxicity can occur: drug-food interaction, overdose, or drug-drug interactions. The most common MAOI toxicity involves the interaction with tyramine-containing foods. [ncbi.nlm.nih.gov]

Epidemiology There has been a 60% decrease in cases of MAOI exposures in the United States over the last 25 years. In 2015, only 208 cases of MAOI exposures were reported to poison control centers. [ncbi.nlm.nih.gov]

The pathophysiology and management of MAO inhibitor poisoning are discussed. [ncbi.nlm.nih.gov]

Prevention and Treatment Most cases of serotonin syndrome are mild and resolved within 24 hours. [nytimes.com]

When you take an MAOI, you must also follow a special diet and avoid some types of prescription and over-the-counter medications to prevent serious side effects. [health.howstuffworks.com]

If end-organ damage such as myocardial infarction or CVA is prevented, prognosis for full recovery to premorbid status is excellent. The most common catastrophic com... Carr BC. [5minuteconsult.com]

[…] foods, such as wine and cheese MAO normally degrades tyramine, but when inhibited is fully absorbed and displaces catecholamines other sympathomimetics CNS stimulation contraindicated with other 5-HT altering drugs (SSRIs and SNRIs) or meperidine to prevent [step2.medbullets.com]