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Serotonin Syndrome

Has anyone experienced Serotonin syndrome? I think I am hypersensitive to this.

I was taking 300mg Lyrica - Klonopin at night, 5 mg and 50 mg tramadol as needed. I was great at first and then after 5 days I ended up with flu like symptoms. Thought I had the flu. I cut off the tramadol and started back up after "flu" had passed , resumed Tramadol and it happened again.

since then I am torn. When my neck pain becomes intolerable I take the tramadol for relief and then end up with this "mysterious" flu a week or 2 later.

Now last week I had an out patient shoulder surgery and was given Percocet 10/325 and was told to stay off tramadol ( I had not take any for 3 weeks anyway). after 4 days I stopped Percocet and ended up with the 'flu" again. I didn't think I was on that stuff long enough to experience withdrawal. I think I am hypersensitive to these types of pain meds.

any similar stories?


  • I'm sorry. No I haven't but I was wondering... Have you tried a 'simple' pain killer like Oxycodone or morphine? Did you have reactions after IV surgery meds? Some of the new narcotics with all the tamper/abuse coatings cause me stomach problems & I know others who have reactions. I was wondering if it could be the other stuff in the meds that your body doesn't like.

    Just a thought. I hope you find some answers.
    Osteoarthritis & DDD.
  • sandisandi Posts: 6,343
    edited 08/29/2014 - 4:08 AM
    Serotonin syndrome is a potentially life threatening drug reaction that causes the body to have too much serotonin, a chemical produced by nerve cells.

    Serotonin syndrome most often occurs when two drugs that affect the body's level of serotonin are taken together at the same time. The drugs cause too much serotonin to be released or to remain in the brain area.

    For example, you can develop this syndrome if you take migraine medicines called triptans together with antidepressants called selective serotonin reuptake inhibitors (SSRIs) and selective serotonin/norepinephrine reuptake inhibitors (SSNRIs). Popular SSRI's include Celexa, Zoloft, Prozac, Zoloft, Paxil, and Lexapro. SNRI's include Cymbalta and Effexor. Brand names of triptans include Imitrex, Zomig, Frova, Maxalt, Axert, Amerge, and Relpax.

    The FDA recently asked the manufacturers of these types of drugs to include warning labels on their products that tell you about the potential risk of serotonin syndrome. Talk to your doctor before stopping any medication.

    Serotonin syndrome is more likely to occur when you first start or increase the medicine.

    Older antidepressants called monoamine oxidase inhibitors (MAOIs) can also cause serotonin syndrome with the medicines describe above, as well as meperidine (Demerol, a painkiller) or dextromethorphan (cough medicine).

    Drugs of abuse, such as ecstasy and LSD have also been associated with serotonin syndrome.

    Symptoms occur within minutes to hours, and may include:

    Agitation or restlessness
    Fast heart beat and high blood pressure
    Increased body temperature
    Loss of coordination
    Overactive reflexes
    Rapid changes in blood pressure
    Exams and Tests
    The diagnosis is usually made by asking questions about your medical history, including the types of drugs you take.

    To be diagnosed with serotonin syndrome, you must have been taking a drug that changes the body's serotonin levels (serotonergic drug) and have at least three of the following signs or symptoms:

    Heavy sweating not due to activity
    Mental status changes such as confusion or hypomania
    Muscle spasms (myoclonus)
    Overactive reflexes (hyperreflexia)
    Uncoordinated movements (ataxia)
    Serotonin syndrome is not diagnosed until all other possible causes have been ruled out, including infections, intoxications, metabolic and hormone problems, and drug withdrawal. Some symptoms of serotonin syndrome can mimic those due to an overdose of cocaine, lithium, or an MAOI.

    If you have just start taking or increased the dosage of a tranquilizer (neuroleptic drug), other conditions such as neuroleptic malignant syndrome will be considered.

    Tests may include:

    Blood cultures (to check for infection)
    Complete blood count (CBC)
    Drug (toxicology) screen
    Electrolyte levels
    Electrocardiogram (ECG)
    Kidney and liver function tests
    Thyroid function tests
    Patients with serotonin syndrome should stay in the hospital for at least 24 hours for close observation.

    Treatment may include:

    Benzodiazepines such as diazepam (Valium) or lorazepam (Ativan) to decrease agitation, seizure-like movements, and muscle stiffness
    Cyproheptadine (Periactin), a drug that blocks serotonin production
    Fluids by IV
    Withdrawal of medicines that caused the syndrome
    In life-threatening cases, medicines that keep your muscles still (paralyze them) and a temporary breathing tube and breathing machine will be needed to prevent further muscle damage.

    Outlook (Prognosis)
    Patients may get slowly worse and can become severely ill if not quickly treated. Untreated serotonin syndrome can be deadly. However, with treatment, symptoms can usually go away in less than 24 hours.

    Possible Complications
    Uncontrolled muscle spasms can cause severe muscle breakdown. The products produced when the muscles break down are released into your blood and eventually go through the kidneys. This can cause severe kidney damage if not recognized and treated appropriately. With appropriate treatment, the condition is reversible.

    When to Contact a Medical Professional
    Call your health care provider right away if you have symptoms of serotonin syndrome.
    Always tell all of your healthcare providers what medicines you take. Patients who take triptans with SSRIs or SNRIs should be closely followed, especially right after starting a medicine or increasing its dosage.

    Alternative Names
    Hyperserotonemia; Serotonergic syndrome
  • I got hurt and the doctor gave me tramadol. I thought it was a wonder drug. I took it consistently for about a month since I had such bad pain (bad disk in neck that had not been discovered yet). Within the month, every time I took the drug, I would sob and I am not the crying type. I realized it was the tramadol. I begged my doctor for hydrocodone and he gave it to me. No more crying. A month later, I tried another tramadol and my heart began skipping beats and I got anxiety. The doctors are ignorant of the fact that it is addictive and worse than hydrocodone to get off of! I am thankful that I got the hydrocodone instead, but now I am afraid to ever try Tramadol again. I guess it does work on the same opiate receptors (is what I have been told) and so you might not have issues with the opiates so much as tramadol, which can cause the serotonin syndrome. Since the tramadol works on the opiate receptors, maybe using Percocet for awhile too, caused you to have withdrawal. I have talked to drug counselors over the past year---I was not "addicted" but dependent on hydrocodone after taking it six months last year, so I talked to some of them about the aftermath of taking the opiates. They all hated Tramadol and told me how horrible it was to get off of. Bet you would do okay with Percocet or hydrocodone. None are a picnic to stop taking. Last year, I took six weeks to get off 40 mg. of hydrocodone. Clonidine helped a lot and made some of the withdrawal much more tolerable. Maybe if you stop taking any of the opiates, gradually reduce the dose to avoid "the flu"!!! But personally, I would avoid Tramadol. Nasty stuff. Really messed up my emotions after awhile.

    I currently take gabapentin for some residual nerve pain. It's like Lyrica. I hate the fluid retention and weight gain. Can't wait to get off that stuff in due time.

    Take care. I was totally ignorant of all these drugs until last year. No one warned me or explained them to me---not even my doctor. I did not know about "dependency" where the body becomes dependent (not addicted). I tried to cut my dose of hydrocodone and found myself with anxiety, diarrhea and insomnia. I did not know that I was dependent until that point because I never craved pills and never have. Anyway, you might look at some websites about the various narcotics. I looked on rehab websites to find some of the best information and many of the counselors will talk to you and explain the drugs to you. I had no clue---even about Tramadol until I did some research and then realized that was why I was crying all the time. My serotonin was being affected.

    Just food for thought---not a doctor's advice---just another person who has been through the wringer over the past year!
  • BronsterMonsterBBronsterMonster Posts: 9
    edited 09/08/2014 - 5:17 AM
    Hi Paradiddle,
    I have had the joy of experiencing serotonin syndrome.
    I was taking Tramadol for chronic hip pain at the same time as an antidepressant (I can't remember which one).
    About a week or two in I started hallucinating. I could handle that as I had experienced it before on other Opiods. Then the sweating started (I would wake up drenched, had to change three to four times a night), anxiety, racing heart and extreme confusion all set in. I was acting extremely irrationally and even now I can't connect with that person, if that makes sense.
    My partner was away at the time for 5 weeks. He came back to a blabbering mess. Took me to the doctors who took me off the Tramadol and replaced it with Endone. I was better after a few days.
    The Endone was ok but I started having problems with my stomach and diarrhoea. So I now take Targin which has no where near the side effects. I still occasionally have the hallucinations and sweat but none of the other issues are evident.
    I never experienced flu like symptoms though.
    Hope this helps :)
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