SEROTONIN SYNDROME DUE TO MULTIPLE PSYCHIATRIC DRUGS INCLUDING CHLORPROMAZINE: A CASE REPORT AND

Mr. Hosanna Jacob Ezekiel B., Dr. M. K. Sundar Sri, Dr. M. Kalaiarasan*

ABSTRACT

Background: Serotonin syndrome is a potentially life-threatening adverse drug reaction resulting from excessive serotonergic activity in the central and peripheral nervous systems. It most commonly occurs following the use of multiple serotonergic medications, drug interactions, or recent dose escalation of psychiatric drugs. Early recognition is essential because the condition can rapidly progress and mimic several neurological and infectious disorders. Case Presentation: A 38-year-old male with a history of schizophrenia and depressive symptoms presented with agitation, confusion, excessive sweating, tremors, muscle rigidity, hyperreflexia, inducible clonus, tachycardia, hypertension, and hyperthermia following recent exposure to multiple psychotropic medications, including sertraline, chlorpromazine, and tramadol. Laboratory investigations revealed elevated creatine kinase levels, while infectious, metabolic, and structural neurological causes were excluded through appropriate diagnostic workup. The diagnosis of serotonin syndrome was established based on clinical findings and fulfillment of the Hunter Serotonin Toxicity Criteria. All suspected medications were discontinued immediately, and the patient was treated with intravenous fluids, lorazepam, cyproheptadine, external cooling measures, and close monitoring. Conclusion: The patient showed significant clinical improvement within 48 hours and achieved complete recovery without complications. This case highlights the importance of early recognition of serotonin syndrome, careful medication review, and prompt initiation of appropriate treatment. Increased awareness of potential drug interactions among psychiatric medications is essential to prevent serious morbidity and ensure favorable patient outcomes.

Keywords: Serotonin Syndrome, Sertraline, Chlorpromazine, Tramadol, Psychotropic Drugs, Drug Interaction, Cyproheptadine, Adverse Drug Reaction.