Q. I have been diagnosed with serotonin syndrome brought on by a drug interaction between Cymbalta, gabapentin, tramadol and a low dose of Prozac. It caused me a lot of problems, including agitation, dizziness, muscle spasms and joint pain so bad my doctor tested me for lupus and rheumatoid arthritis. I also was unable to sleep even with Ambien. My pupils were dilated, my vision was blurry and I had horrible palpitations.
It took a long time before anyone figured out that the problems were due to the interaction. Why aren’t doctors more familiar with the effects of serotonin syndrome so that it can be diagnosed more promptly? I am just lucky I didn’t have a seizure while all this was happening.
Because of the serotonin syndrome, I’ve had to eliminate Cymbalta. The side effects of withdrawal are horrific.
A. Serotonin syndrome is a potentially life-threatening drug reaction. Cymbalta, Prozac and tramadol probably all contributed to your serotonin overload.
Classic symptoms include agitation, confusion, hallucinations, rapid heart rate (palpitations), diarrhea, nausea or vomiting, fever, muscle spasms, overactive reflexes and rapid changes in blood pressure. There are, however, many other possible symptoms, including seizures and severe joint pain (Physical Therapy, June, 2008). Doctors and pharmacists must be vigilant to prevent such drug interactions.
Two people we know suffered from serotonin syndrome. One died, while the other recovered after a week in a coma. We describe these cases and other deadly drug interactions in our book, Top Screwups Doctors Make and How to Avoid Them, available in libraries and online at PeoplesPharmacy.com.
