Academic Preschool Consultant

Serotonin syndrome - Possible interactions of a combined administration of tryptophan and serotonin reuptake inhibitors



The serotonin syndrome is a possible side effect of the combined use of the amino acid tryptophan, along with various drugs from the class of serotonin reuptake inhibitors (SSRIs). Previous studies describe a dose-response relationship of this side effect. That is, the higher the dose of fluoxetine and tryptophan, for example, the greater the risk for the occurrence of serotonin syndrome. In the use of 20 mg fluoxetine per day (recommended standard dose) with daily 2 to 4 g tryptophan occurred in a controlled study over an observation period of 8 weeks, no cases of serotonin syndrome (Levitan et al. 2000).

The previously published study data suggest that there is under the standard dosage of an SSRI together with tryptophan single doses of less than 1 g of tryptophan per day, no increased risk for the occurrence of serotonin syndrome. For a validity period for 8 weeks also are no data for compatibility, so that long-term use of the combination of SSRIs and tryptophan can not currently be recommended.

Particular caution is advised when high doses of a serotonin reuptake inhibitor (eg fluoxetine more than 20 mg per day) together with tryptophan to apply. Under these conditions, cases of serotonin syndrome have been reported (Steiner et al. 1986). For treatment mit einem SSRI, die über die über die in der Gebrauchsinformation aufgeführte Standard-Dosierung hinausgeht, sollte keine Supplementation mit L-Tryptophan erfolgen.


Literatur:

Levitan RD, Shen JH, Jindal R, Driver HS, Kennedy SH, Shapiro CM. Preliminary randomized double-blind placebo-controlled trial of tryptophan combined with fluoxetine to treat major depressive disorder: antidepressant and hypnotic effects. J Psychiatry Neurosci. 2000 Sep;25(4):337-46.

Steiner W, Fontaine R. Toxic reaction following the combined administration of fluoxetine and L-tryptophan: five case reports. Biol Psychiatry. 1986 Sep;21(11):1067-71.


Das You may be interested:

• tryptophan - interaction with the analgesic tramadol

• The consequences of long-term tryptophan supplementation: interactions between tryptophan and dopamine

Searches: L- tryptophan, serotonin syndrome, side effect tryptophan, serotonin reuptake inhibitor, fluoxetine