Previously we were asked to evaluate a 50 year old patient who was admitted for chest pain and SOB. The patient had a prior history of asthma and received a working diagnosis of pericarditis or possible pleurisy. The patient was started on a course of colchicine and ibuprofen with prn Norco for pain.
Over the course of the next 2 weeks the patient began to experience increasing respiratory discomfort that was thought to be secondary to the respiratory depressant effects of the Norco. As a result, the patient was switched to tramadol. After a month of prn tramadol, the patient began to experience episodes of tachycardia with worsening chest pain along with intermittent hot flashes.
But how is it that a patient is ever prescribed a Zofran and Celexa while receiving a tramadol? Are prescribers completely dismissing Serotonin Syndrome and its potential lethal consequences? Or is there a lack of awareness? And how does pharmacy allow this combination to be prescribed without first probing to ensure that the risk vs benefit warrants dispensing this dangerous cocktail? Perhaps we are failing to emphasize the dangers associated with the condition known as Serotonin Syndrome. The following links may serve as a good refresher in the prevention and diagnosis of this potentially lifethreatening condition:
Serotonin Syndrome Associated With Tramadol: http://ow.ly/lI5h30jieov