Serotonin syndrome caused by moclobemide - Clomipramine interaction

Abstract

The serotonin syndrome is due to serotoninergic hyperstimulation, which is caused, mostly, by the interaction between a serotoninergic agent and a serotonin-enhancing drug, in particular the monoaminooxidase inhibitors. A male patient, 21 years old, with presenting symptoms and findings as unconsciousness, flushing, diaphoresis, tremor, elevated body temperature, disseminated muscular rigidity and increased salivation is reported. In the ICU, supportive treatment were applied. After his conscious was normalized, the patient explained that he had taken 900 mg moclobemide and 150 mg clomipramine together to provide strong effect on his depression. This patient was accepted as serotonin syndrome and rhabdomyolysis related to this syndrome, induced by moclobemide plus clomipramine interaction. Also history, laboratory and clinical data confirmed the diagnosis of serotonin syndrome according to Sternbach's criteria. As we observed and as reported in the recent literature, the most significant adverse effects during anti-depressive therapy appear to be drug interactions between clomipramine and moclobemide which could be fatal.