RESUMO
BACKGROUND: A recent series of case reports has demonstrated a significant, previously unrecognized drug interaction between serotonin reuptake inhibitors (SRIs) and methylene blue (MB). OBJECTIVE: The authors review the case reports and clinical audits relevant to this interaction and consider the diagnosis of serotonin syndrome in these cases. METHOD: Articles were obtained from a systematic search of MEDLINE and PsychInfo databases, and from the bibliographies of relevant articles. Studies were considered relevant if the patient received MB and developed an acute confusional state, neuropsychiatric complications, or autonomic instability. RESULTS: The review identified nine case reports and two retrospective reviews; 26 patients developed an acute confusional state after MB infusion; 24 of these patients were taking an SRI, and 1 was taking clomipramine. Serotonin syndrome was a possible diagnosis in all 25 of these patients. CONCLUSION: SRIs can interact with MB, causing a serious adverse reaction consistent with serotonin syndrome.
Assuntos
Azul de Metileno/toxicidade , Inibidores Seletivos de Recaptação de Serotonina/toxicidade , Síndrome da Serotonina/etiologia , Idoso , Antidepressivos Tricíclicos/administração & dosagem , Antidepressivos Tricíclicos/toxicidade , Clomipramina/administração & dosagem , Clomipramina/toxicidade , Interações Medicamentosas , Feminino , Humanos , Infusões Intravenosas , Masculino , Azul de Metileno/administração & dosagem , Pessoa de Meia-Idade , Complicações Pós-Operatórias/induzido quimicamente , Complicações Pós-Operatórias/diagnóstico , Síndrome da Serotonina/diagnóstico , Inibidores Seletivos de Recaptação de Serotonina/administração & dosagemRESUMO
PURPOSE: To report a case of autonomic, neurological and neuromuscular instability following methylene blue infusion for parathyroidectomy; to advance the argument for a diagnosis of serotonin syndrome; and to consider this diagnosis in previous, unexplained reports of adverse reactions amongst patients undergoing parathyroidectomy using methylene blue. CLINICAL FEATURES: Methylene blue was administered to a 58-yr-old woman undergoing a parathyroidectomy under general anesthesia. The patient had a background of obsessive compulsive disorder treated with paroxetine. Postoperatively, she demonstrated symptoms and signs of serotonin syndrome; specifically tachycardia, agitation, dystonia and abnormal eye movements. These clinical findings spontaneously resolved themselves over the subsequent 48 hr. CONCLUSION: An interaction between methylene blue and serotonergic agents may give rise to the serotonin syndrome. Consideration should be given to avoiding methylene blue in patients taking serotonergic agents. The diagnosis should be considered in patients with autonomic, neuromuscular or neurological changes and should be managed accordingly.
