A Case of Serotonin Syndrome Due to Amantadine and Escitalopram in End-Stage Renal Disease / 대한내과학회지

ABSTRACT

Serotonin syndrome is a potentially life-threatening adverse drug reaction caused by excessive serotonergic activity in the nervous system. It is characterized by a triad of mental status changes, autonomic hyperactivity, and neuromuscular abnormalities. Escitalopram is a selective serotonin reuptake inhibitor. Amantadine, an anti-influenza agent, is commonly used for the treatment of parkinsonism; it also has serotonergic activity. Amantadine can induce toxicity in patients with renal dysfunction because it is excreted mainly in the urine. We report a rare case of serotonin syndrome in a 73-year-old woman with Parkinson's disease, depression, and end-stage renal disease undergoing maintenance hemodialysis. She presented with confusion, myoclonus, and fever after starting escitalopram for her depression while on amantadine for parkinsonism. Based on this case, amantadine as well as escitalopram should be placed on the list of medications that can precipitate serotonin syndrome. The side effects of these drugs should be monitored, especially in end-stage renal disease.