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TABLE 6

Medications and Other Agents Associated With Serotonin Syndrome

Psychiatric drugs 
 Antianxiety drugs: direct serotonin antagonists 
  Buspirone 
 Antimanic drugs: increased postsynaptic receptor sensitivity 
  Lithium 
  Antidepressants 
 Antidepressants: tricyclic antidepressants 
  Amitriptyline 
  Clomipramine 
  Nortriptyline 
 Antidepressants: monoamine oxidase inhibitors 
  Phenelzine 
 Antidepressants: SSRIs 
  Citalopram 
  Fluoxetine 
  Paroxetine 
  Sertraline 
 Antidepressants: 5HT2A receptor blockers 
  Nefazodone 
  Trazodone 
  Antidepressants: serotonin-norepinephrine reuptake inhibitors 
  Venlafaxine 
  Duloxetine 
Nonpsychiatric drugs 
 Skeletal muscle relaxants 
  Cyclobenzaprine 
 Opioid analgesics 
  Fentanyl 
  Meperidine 
  Oxycodone 
  Pentazocine 
  Tramadol 
  Hydrocodone 
 Antibiotics 
  Linezolid 
 Antiretroviral (protease inhibitor) 
  Ritonavir 
 Anticonvulsants 
  Carbamazepine 
  Valproic acid 
 Antiemetics 
  Metoclopramide (Reglan) 
  5HT3 receptor antagonists 
  Ondansetron 
 Antimigraine drugs 
  Ergot alkaloids: ergotamines 
  Triptans (5 HT1B and 5HT1B receptor agonists; eg, sumatriptan) 
  Antiparkinsonian drugs 
  Carbidopa/levodopa 
 Bariatric medications (weight reduction) 
  Sibutramine 
Over-the-counter medications 
 Dextromethorphan (cough suppressants and cold remedies) 
Drugs of abuse 
 3,4–Methylenedioxymethamphetamine (Ecstasy) 
 Cocaine 
 Lysergic acid diethylamide 
 Methamphetamine 
Herbals 
Hypericum perforatum (St John’s wort) 
Dietary supplements 
Panax ginseng (ginseng) 
 L-tryptophan 
 5-hydroxytryptophan 
Psychiatric drugs 
 Antianxiety drugs: direct serotonin antagonists 
  Buspirone 
 Antimanic drugs: increased postsynaptic receptor sensitivity 
  Lithium 
  Antidepressants 
 Antidepressants: tricyclic antidepressants 
  Amitriptyline 
  Clomipramine 
  Nortriptyline 
 Antidepressants: monoamine oxidase inhibitors 
  Phenelzine 
 Antidepressants: SSRIs 
  Citalopram 
  Fluoxetine 
  Paroxetine 
  Sertraline 
 Antidepressants: 5HT2A receptor blockers 
  Nefazodone 
  Trazodone 
  Antidepressants: serotonin-norepinephrine reuptake inhibitors 
  Venlafaxine 
  Duloxetine 
Nonpsychiatric drugs 
 Skeletal muscle relaxants 
  Cyclobenzaprine 
 Opioid analgesics 
  Fentanyl 
  Meperidine 
  Oxycodone 
  Pentazocine 
  Tramadol 
  Hydrocodone 
 Antibiotics 
  Linezolid 
 Antiretroviral (protease inhibitor) 
  Ritonavir 
 Anticonvulsants 
  Carbamazepine 
  Valproic acid 
 Antiemetics 
  Metoclopramide (Reglan) 
  5HT3 receptor antagonists 
  Ondansetron 
 Antimigraine drugs 
  Ergot alkaloids: ergotamines 
  Triptans (5 HT1B and 5HT1B receptor agonists; eg, sumatriptan) 
  Antiparkinsonian drugs 
  Carbidopa/levodopa 
 Bariatric medications (weight reduction) 
  Sibutramine 
Over-the-counter medications 
 Dextromethorphan (cough suppressants and cold remedies) 
Drugs of abuse 
 3,4–Methylenedioxymethamphetamine (Ecstasy) 
 Cocaine 
 Lysergic acid diethylamide 
 Methamphetamine 
Herbals 
Hypericum perforatum (St John’s wort) 
Dietary supplements 
Panax ginseng (ginseng) 
 L-tryptophan 
 5-hydroxytryptophan 

This is not an all-inclusive list but gives an overview of the wide range of agents that can trigger the serotonin syndrome. Drugs are listed by their therapeutic category. This list is not intended to endorse any given drug or product.

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