Tuesday, January 9, 2024, 5:48 p.m.
‘Serotonin’ is full!’Dr. Teerawat’ lectures on the SS phenomenon. Take medicine and die or else have a yellow chin.
9 January 2024 Prof. Dr. Teerawat Hemajutha, Head of the Emerging Disease Health Science Center Faculty of Medicine Chulalongkorn Hospital Posted a message via Facebook “Thirawat Hemachudha Thiravat Hemachudha” topic “Take medicine and die..or yellow chin, SS serotonin retention phenomenon” as follows…
Take medicine and die..or have a yellow chin, SS phenomenon
Serotonin retention
It’s known as medicine. If you take the wrong type, the wrong size, take many things together (polypharmacy), if you don’t know the origin, given to different people, from different doctors, your own body becomes a battlefield for medicine.
Results instead of healing Relieve symptoms of disease turned out to be a punishment Although each type of medicine given is true to the symptoms or disease, But the drugs cross groups. Fight each other fiercely Makes the effect less than it should be or more than it should be so much that it causes poisoning.
An example the doctor gave me earlier. It is a migraine pain relief drug from the ergot group itself. If you eat too much Causes spasm of blood vessels The blood vessels to the arms and legs shrink, causing hands or feet to be amputated, or blood vessels in the heart and brain to become clogged. Heart attack causing paralysis
and even take the normal size, but if taking other medicines as well Instead, it works too much and will have the same effect, or Ergot increases the effect of other drugs, causing toxicity due to an overdose of other drugs (happy health, doctors are stubborn, “Ergot” drugs can’t be used properly, blood vessels, heart, brain solid arms and legs)
Another phenomenon That happens frequently and is not generally acknowledged. But the great danger is the buildup of serotonin, which causes abnormalities in the autonomic nervous system, which comes in the form of an irregular heartbeat, high fever, and abnormal blood pressure, including Muscle abnormalities cause muscles to break down, arms, legs, and body, weakness, pain, and muscle fragments that overflow into the bloodstream and settle in the kidneys, causing kidney failure. As well as having brain abnormalities in the form of agitation, fussiness, depression, seizures, coma, and serotonin syndrome (SS).
Not all of these symptoms occur. But any one thing can happen. such as blood pressure disorders or heart rhythm, or in the form of muscle pain, weakness, along with fever, and such symptoms are similar to those occurring with various infections, whether bacterial or viral. Causing the need to investigate to find the cause more than it can be concluded that it is caused by Serotonin retention syndrome
We ourselves have patients like this. that we encountered with symptoms of confusion, fever, muscle abnormalities Blood pressure and pulse fluctuations, etc. It takes time for each person to conclude the cause. You must pay at least 100,000 to 200,000 baht for each test, including blood tests, cerebrospinal fluid, and brain computers. and testing for various infections to ensure that they are not caused by infection
Although there are recommendations for diagnosing SS called Sternbach criteria, which includes:
Symptoms occur after taking drugs that increase serotonin or increasing the dosage of drugs already taken. Combined with confusion, restlessness, staggering, sweating, diarrhea, muscle spasms or stiffness. Trembling or have an abnormally high fever However, the cause of infection must be ruled out. drug use or there is an abnormality Variations in the mineral system in the body Liver, kidneys and hormonal system
But even so Reports abroad are still leaked, unable to provide a timely diagnosis. This is despite the release of new guidelines called Hunter serotonin toxicity criteria.
This is due to the complexity of the symptoms. and besides Massive use of drugs to relieve symptoms or treating various conditions, causing the SS syndrome to increase and is currently being watched
Medicines that are regularly used Unthinkable to cause harmful effects, these include the migraine painkiller Ergot and a newer expensive drug called triptan. They are also used in combination with antidepressant drugs. There are many other things called SSRIs, SNRIs, and older drugs, including Trazodone, nefazodone, clomipramine, venlafaxine, mirtazapine, and the painkiller tramadol, and many more. These are divided according to the mechanism of the drugs that cause congestion.
Groups that inhibit serotonin reuptake, such as weight loss drugs Phentermine, antidepressants, Buproprion, nefazodone, trazodone
Antiemetic medicine granisetron ondansetron
Antihistamines such as chlorpheniramine
Opiates such as levomethorohan, levorphanol, meperidine, methadone, pentazocine, pethidine, tapentadol, tramadol, cocaine, ecstasy, St John’s wort (hypericum perforatum), cough medicine, dextromethorphan SNRI antidepressant drugs desvenlafaxine duloxetine venlafaxine SSRI group citalopram escitalopram fluoxetine fluvoxamine paroxetine sertraline TCA group such as amitriptyline is a ton.
Mechanisms that inhibit the release of serotonin include the anti-anxiety drugs buspirone, MAOIs, and migraine analgesics, including triptans including almotriptan, eletriptan, frovatriptan, naratriptan, rizatriptan, sumatriptan, zolmitriptan, and the herbal St John’s wort.
Groups that increase serotonin production, diet pills, phentermine, dietary supplements, L-tryptophan, and drugs, cocaine.
Group that increases secretion of substances Antidepressants mirtazapine, diet pills, phentermine, pain relievers, meperidine, oxycodone, tramadol, ecstasy, dextromethorphan Parkinson’s disease medicine levodopa
Serotonin receptor modulators, anti-anxiety drugs, buspirone, antidepressants, mirtazapine, trazodone, migraine drugs, ergot, triptans, LSD, bipolar drugs, lithium, antiemetics, and intestinal motility. metoclopramide
A group that inhibits damage in the liver CYP450Microsomal oxidases by inhibiting CYP2D6 include antidepressant substrates including dextromethorphan oxycodone phentermine risperidone tramadol
CYP3A4 inhibitors include ciprofloxacin ritonavir and substrates including methadone oxycodone venlafaxine.
CYP2C19 inhibitors, fluconazole and its substrates, including citalopram
In addition, the group that is widely used in Thailand right now is Medicines that reduce pain caused by nerves or nervous system disorders, gabapentin, pregabalin, and
The drugs that cause the SS phenomenon may occur with the use of high doses of the above mentioned single drugs. or use multiple drugs together at the normal dosage of each. Take Parkinson’s disease patients, for example. You can take levodopa to relieve stiffness, such as vopar madopar simemet, and feel depressed.
Anxiety relievers, stress relievers, anti-depressants, help with sleep, and if there is a bone in your back that is pressing against a painful nerve, you will get painkillers. Together these groups have caused the SS congestion phenomenon, and now even antihistamines are widely used for a long time. (antihistamine) Chlorpheniramine or CPM when faced with other groups, such as migraine drugs, is also at risk.
So life is not easy. Both doctors and pharmacists who diagnose and prescribe medicine, and sick people themselves who go to many doctors and do not tell each doctor what medicines they use. Or go buy some medicine yourself? Moreover, the doctor had no idea that these various medicines were commonly used when reconstructing the body. It will cause serious consequences that are difficult to diagnose, extremely difficult, and of course require admission to the ICU. And if you’re lucky, when the toxic effects of various groups of drugs are gone you will gradually recover.
In summary, the medicine is good. But if the medicine is too much If you don’t die, you can get a yellow chin.
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2024-01-09 10:48:00
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