Serotonergic drugs

Drugs most commonly associated with serotonergic toxidrome are listed in Drugs most commonly associated with serotonergic toxidrome and can cause serotonin excess through different pharmacological actions. Serotonergic toxidrome can be caused by a single serotonergic drug, particularly in poisoning, but most cases arise from co-ingestion of two or more serotonergic drugs.

Table 1. Drugs most commonly associated with serotonergic toxidrome
Drug class	Drugs
Drugs that decrease serotonin reuptake
selective serotonin reuptake inhibitors (SSRIs)	citalopram, dapoxetine, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline, vortioxetine
serotonin and noradrenaline reuptake inhibitors (SNRIs)	atomoxetine, desvenlafaxine, duloxetine, reboxetine, venlafaxine
some tricyclic antidepressants (TCAs)	clomipramine, imipramine
some opioids	high risk: dextromethorphan, tramadol, pethidine lower risk: methadone, tapentadol
herbal	St John’s wort (Hypericum perforatum)
Drugs that decrease serotonin metabolism
monoamine oxidase inhibitors (MAOIs)	irreversible nonselective: phenelzine, tranylcypromine reversible selective: moclobemide, lamotrigine other: linezolid, methylene blue, isoniazid
Drugs that increase serotonin release
stimulants	amfetamines, phentermine, metamfetamine methylenedioxymetamfetamine (MDMA or ‘ecstasy’), cocaine, cathinones
opioids	all opioid drugs have occasional serotonergic effect by indirectly stimulating serotonin release
Drugs that increase serotonin synthesis
sedative amino acid	L-tryptophan
Drugs that are serotonin receptor agonists
hallucinogens	lysergic acid diethylamide (LSD), 2C–substituted phenylethylamines (eg ‘NBOMe’)
mood stabiliser	lithium