Amitriptilina serotoninérgica

Resumen

Introducción

El síndrome serotoninérgico es un cuadro clínico debido a altos niveles de serotonina. Está causado por el uso de uno o varios fármacos con actividad serotoninérgica de forma concomitante. Su diagnóstico es clínico y se lleva a cabo según criterios diagnósticos.

Caso clínico

Paciente de 65 años en seguimiento de larga evolución por trastorno afectivo bipolar con reciente instauración de tratamiento con amitriptilina. En urgencias se observa temblor distal, ataxia, bradipsiquia, desorientación temporoespacial, discinesia orolingual, miocolonías oculares y diaforesis. Se descartan posibles etiologías causantes del cuadro.

Resultados

Apareció un síndrome serotoninérgico tras la instauración de amitriptilina. No fueron necesarias medidas invasivas de soporte. Se retiró el tratamiento con psicofármacos y se instauraron progresivamente aquellos sin actividad serotoninérgica.

Conclusiones

No es necesario el uso concomitante de varios fármacos serotoninérgicos, sino que puede aparecer este síndrome con el uso de un fármaco instaurado de forma brusca.

Abstract

Introduction

Serotoninergic syndrome is a clinical disorder due to high levels of serotonin. It is caused by the concomitant use of one or several drugs with high serotoninergic activity. Its diagnosis is clinical, and is made following some diagnostic criteria.

Clinical case

The case concerns a 65 year-old patient on long-term follow due to a bipolar affective disorder, and who recently started treatment with amitriptyline. In the Emergency Department, distal tremor was observed, as well as ataxia, bradypsychia, time-space orientation, orolingual dyskinesia, ocular myoclonus, and diaphoresis. Possible aetiological causes of the syndrome were ruled.

Results

A serotoninergic syndrome appeared after starting amitriptyline treatment. Invasive support measures were not necessary. The treatment with psychiatric drugs was withdrawn and gradually started with those without serotoninergic activity.

Conclusions

The concomitant use of several serotoninergic drugs is not necessary, although this syndrome can appear with the use of a suddenly introduced drug.