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A Case of Serotonin Syndrome Due to Amantadine and Escitalopram in End-Stage Renal Disease

말기신장병에서 Amantadine과 Escitalopram에 의한 세로토닌 증후군 1예

  • Choi, Jun-Seok (Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Lee, Eun-Kyoung (Department of Internal Medicine, Dankook University College of Medicine)
  • 최준석 (울산대학교 의과대학 서울아산병원 내과) ;
  • 이은경 (단국대학교 의과대학 내과학교실)
  • Published : 2012.07.01

Abstract

Serotonin syndrome is a potentially life-threatening adverse drug reaction caused by excessive serotonergic activity in the nervous system. It is characterized by a triad of mental status changes, autonomic hyperactivity, and neuromuscular abnormalities. Escitalopram is a selective serotonin reuptake inhibitor. Amantadine, an anti-influenza agent, is commonly used for the treatment of parkinsonism; it also has serotonergic activity. Amantadine can induce toxicity in patients with renal dysfunction because it is excreted mainly in the urine. We report a rare case of serotonin syndrome in a 73-year-old woman with Parkinson's disease, depression, and end-stage renal disease undergoing maintenance hemodialysis. She presented with confusion, myoclonus, and fever after starting escitalopram for her depression while on amantadine for parkinsonism. Based on this case, amantadine as well as escitalopram should be placed on the list of medications that can precipitate serotonin syndrome. The side effects of these drugs should be monitored, especially in end-stage renal disease.

세로토닌 증후군은 신경계의 세로토닌 활성도가 지나치게 증가하여 발생하는 것으로 정신상태의 변화, 자율신경의 과다활동 그리고 신경근육 이상이라는 세 가지 증후로 나타나는 비교적 드문 질환이다. Escitalopram은 selective serotonin reuptake inhibitor로 세로토닌을 활성화시킨다. Amantadine은 인플루엔자 및 파킨슨병 치료제이나 세로토닌 상승 효과가 있다. 또한 amantadine은 소변으로 배설되므로 신기능 저하 환자에서는 독성이 증가한다. 저자들은 말기신장병으로 혈액투석을 받으면서 파킨슨병 및 주요우울증으로 amantadine 과 escitalopram을 복용하던 73세 여자 환자에게서 중증의 세로토닌 증후군이 발생하였기에 보고한다. 환자는 의식 저하, 고열, 자발성 간대경련을 보였으며 원인 약제 중단과 적극적 지지요법으로 호전되었다. 이 증례를 고려하여 amantadine과 escitalopram을 세로토닌 증후군 발생 가능한 약물로 포함시켜야 하며 특히 신부전 환자에서 투여할 때에는 발생 위험이 증가하므로 적극적인 감시가 필요하다.

Keywords

References

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