![]() ![]() More work is needed to answer this question more completely.Ī 20 year-old man was found confused by his family. Our cases suggest supra-therapeutic dextromethorphan doses with a therapeutic amount of a SSRI are required for serotonin syndrome. ![]() To our knowledge, these are the first cases to use serum levels of dextromethorphan and a SSRI to confirm dextromethorphan-induced serotonin syndrome. In case two, serum drug levels from admission revealed a dextromethorphan level of 2820 ng/mL, sertraline of 12.5 ng/mL (normal<200), and caffeine of 1.4 μg/mL (normal≤ 9 μg/mL). In case one, serum drug levels from admission revealed a dextromethorphan level of 950 ng/mL (normal<5), escitalopram of 23 ng/mL (normal<200), chlorpheniramine of 430 ng/mL (normal<20) and undetectable levels of aripiprazole and benztropine. We present two cases of serotonin syndrome associated with supra-therapeutic doses of dextromethorphan and therapeutic levels of a selective serotonin reuptake inhibitors (SSRI). ![]() The lack of published cases suggests therapeutic doses of these drugs are not enough to cause serotonin syndrome. The ability of dextromethorphan to potentiate serotonin levels and lead to serotonin syndrome is well known but few case reports are published.
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