| Dextromethorphan, chlorphenamine and serotonin toxicity: case report and systematic literature review. | |
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MedLine Citation:
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PMID: 21175434 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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The aim of this review was to describe a patient with serotonin toxicity after an overdose of dextromethorphan and chlorphenamine and to perform a systematic literature review exploring whether dextromethorphan and chlorphenamine may be equally contributory in the development of serotonin toxicity in overdose. A Medline literature review was undertaken to identify cases of serotonin toxicity due to dextromethorphan and/or chlorphenamine. Case reports were included if they included information on the ingested dose or plasma concentrations of dextromethorphan and/or chlorphenamine, information about co-ingestions and detailed clinical information to evaluate for serotonin toxicity. Cases were reviewed by two toxicologists and serotonin toxicity, defined by the Hunter criteria, was diagnosed when appropriate. The literature was then reviewed to evaluate whether chlorphenamine may be a serotonergic agent. One hundred and fifty-five articles of dextromethorphan or chlorphenamine poisoning were identified. There were 23 case reports of dextromethorphan, of which 18 were excluded for lack of serotonin toxicity. No cases were identified in which serotonin toxicity could be solely attributed to chlorphenamine. This left six cases of dextrometorphane and/or chlorphenamine overdose, including our own, in which serotonin toxicity could be diagnosed based on the presented clinical information. In three of the six eligible cases dextromethorphan and chlorphenamine were the only overdosed drugs. There is substantial evidence from the literature that chlorphenamine is a similarly potent serotonin re-uptake inhibitor when compared with dextrometorphan. Chlorphenamine is a serotonergic medication and combinations of chlorphenamine and dextromethorphan may be dangerous in overdose due to an increased risk of serotonin toxicity. |
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Authors:
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Andrew A Monte; Ryan Chuang; Michael Bodmer |
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Publication Detail:
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Type: Case Reports; Journal Article; Review |
Journal Detail:
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Title: British journal of clinical pharmacology Volume: 70 ISSN: 1365-2125 ISO Abbreviation: Br J Clin Pharmacol Publication Date: 2010 Dec |
Date Detail:
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Created Date: 2010-12-23 Completed Date: 2011-03-28 Revised Date: 2011-12-21 |
Medline Journal Info:
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Nlm Unique ID: 7503323 Medline TA: Br J Clin Pharmacol Country: England |
Other Details:
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Languages: eng Pagination: 794-8 Citation Subset: IM |
Copyright Information:
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© 2010 The Authors. British Journal of Clinical Pharmacology © 2010 The British Pharmacological Society. |
Affiliation:
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Rocky Mountain Poison and Drug Center, Denver University of Colorado Denver School of Medicine, Aurora, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Antitussive Agents
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poisoning* Chlorpheniramine / poisoning* Dextromethorphan / poisoning* Humans Male Overdose Serotonin Agents / poisoning* Suicide, Attempted Young Adult |
| Chemical | |
Reg. No./Substance:
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0/Antitussive Agents; 0/Serotonin Agents; 125-71-3/Dextromethorphan; 132-22-9/Chlorpheniramine |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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