Serotonin toxicity precipitated by concomitant use of citalopram and methylene blue

Khavandi, Ali; Whitaker, John; Gonna, Hanney

doi:10.5694/j.1326-5377.2008.tb02168.x

To the Editor: Serotonin toxicity is an under-recognised, potentially fatal syndrome that is becoming more common as the use of serotonergic drugs increases.1 We report a case of serotonin toxicity following the concomitant use of the antidepressant citalopram and methylene blue.

Southmead Hospital, Bristol, United Kingdom.

Correspondence: john.whitaker@trinity-oxford.com

1. Boyer EW, Shannon M. The serotonin syndrome. N Engl J Med 2005; 352: 1112-1120.
2. Ramsay RR, Dunford C, Gillman PK. Methylene blue and serotonin toxicity: inhibition of monoamine oxidase A (MAO A) confirms a theoretical prediction. Br J Pharmacol 2007; 152: 946-951.
3. Kartha SS, Chacko CE, Bumpous JM, et al. Toxic metabolic encephaolopathy after parathyroidectomy with methylene blue localization. Otolaryngol Head Neck Surg 2006; 135: 765-768.

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