Escitalopram/rasagiline interactions
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Serotonin syndrome: case report An elderly woman [exact age not stated] developed serotonin syndrome following concomitant administration of alcoholcontaining homeopathic medicine with rasagiline and escitalopram [not all routes not stated]. The woman, who had Parkinson’s disease for 7 years, presented to an emergency room because of hyperthermia and seizures. Prior to the presentation, she was well while receiving stable doses of rasagiline 1 mg/day and levodopa/carbidopa. One year before the presentation, she had started receiving escitalopram 10mg daily for depression. No dose adjustments with her medications were made. She did not take any alcoholic beverages. Two days before the admission, she had received oral homeopathic medicine at a dose of 15 drops in water thrice daily instead of 5–10 drops in water thrice daily. Within 2h after administration of homeopathic medicine, she developed clonic rhythmic jerking of all her extremities with an intact consciousness. Her symptoms resolved spontaneously, and it was absent during sleep. On the day of admission, after intake of homeopathic medicine, her symptoms recurred. Subsequently, she became unresponsive and was taken to hospital. Upon review of homeopathic medicine packaging, it contained ignatia D12 1g, amanita muscaria [agaricus muscarius] D12 1g, lachesis D30 1g, phosphorus D30 1g, zincum valerate dihydrate D8 1g, magnesium phosphate d12 1g and alcohol [eathanol]/purified water. The homeopathic medicine contained 36% alcohol by volume. At admission, she was unresponsive with generalised tonic-clonic seizures. She was normotensive with tachypneic, tachycardic, hyperthermic and diaphoretic. She was also hyperreflexic with spontaneous clonus on all extremities. Her systemic and neurological examinations were normal. Based on the presentation, it was concluded that, serotonin syndrome was caused by an interaction between rasagiline, escitalopram and alcohol-containing homeopathic medicine. Therefore, the woman started receiving diazepam, which was increased before intubation. Subsequently, she was placed on respiratory support. She also started receiving midazolam with the resolution of seizures. Subsequently, she was initiated on hydration and hypothermia protocol, and her all past medications were stopped. Laboratory tests revealed increased levels of serum creatine kinase MM (CKMM) with myoglobinuria and leucocytosis. Her remaining findings were normal. On the second day of hospitalisation, her sensorium improved, and subsequently, midazolam was titrated off. Her spontaneous clonus resolved with a gradual decrease in CKMM levels. On the fifth day, she was extubated. The woman was slowly re-started on rasagiline and levodopa. After improvement, she was discharged from hospital. Suratos CTR, et al. Serotonin syndrome in a Parkinson disease patient after intake of an ethanol-containing homeopathic medication. Neurodegenerative Disease Management 803515486 10: 219-222, No. 4, Aug 2020. Available from: URL: http://doi.org/10.2217/nmt-2020-0006
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