A Mix of Medicines That Can Be Lethal

NY Times ^ | February 27, 2007 | JANE E. BRODY

[neverdem]

The death of Libby Zion, an 18-year-old college student, in a New York hospital on March 5, 1984, led to a highly publicized court battle and created a cause célèbre over the lack of supervision of inexperienced and overworked young doctors. But only much later did experts zero in on the preventable disorder that apparently led to Ms. Zion’s death: a form of drug poisoning called serotonin syndrome.

--snip--

In its classic form, serotonin syndrome involves three categories of symptoms:

¶Cognitive-behavioral symptoms like confusion, disorientation, agitation, irritability, unresponsiveness and anxiety.

--snip--

Perhaps adding to the diagnostic challenge is the fact that a huge number of drugs — prescription, over the counter, recreational and herbal — can trigger the syndrome. In addition to selective serotonin reuptake inhibitors like Zoloft, Prozac and Paxil and serotonin/norepinephrine reuptake inhibitors like Effexor, the list includes tricyclic antidepressants and MAOIs (for monoamine oxidase inhibitors); narcotic painkillers like fentanyl and tramadol; over-the-counter cough and cold remedies containing dextromethorphan; the anticonvulsant valproate; triptans like Imitrex used to treat and prevent migraines; the antibiotic Zyvox (linezolide); antinausea drugs; the anti-Parkinson’s drug L-dopa; the weight-loss drug Meridia (sibutramine); lithium; the dietary supplements tryptophan, St. John’s wort and ginseng; and several drugs of abuse, including ecstasy, LSD, amphetamines, the hallucinogens foxy methoxy and Syrian rue.

Although serotonin poisoning can be caused by an antidepressant overdose, it more often results from a combination of an S.S.R.I. or MAOI with another serotonin-raising substance. Patients at particular risk, some experts say, are those taking combinations of antidepressant and antipsychotic drugs sometimes prescribed to...

--snip--

Most important to preventing the syndrome is for patients to give each of their doctors a complete list of drugs they regularly take — including prescriptions, over-the-counter medication, dietary supplements and recreational drugs — before a doctor prescribes something new.

[wastoute]

My purpose wasn't to frighten. Hour after hour, day after day, "the system" works but occasionally things happen that shouldn't. It happens in any field. In a factory errors can be detected and bad products held in "QI" but in the hospital errors happen to people. If you try to decrease the amount of hours docs work you increase the number of "handoffs" which are also a big source of errors. If you decrease the workload you dilute the experience they need to learn.