The incidence of serotonin syndrome was significantly higher in patients receiving both fentanyl and a serotonergic agent (0.09%) compared to those on serotonergic agents alone (0.005%).
Observational (n=112,045)
No
Does fentanyl increase the incidence of serotonin syndrome in patients on serotonergic agents?
While the relative risk of serotonin syndrome is statistically higher when fentanyl is co-administered with serotonergic agents, the absolute incidence remains extremely low at less than 1 in 1,000 patients.
Tasa de eventos absoluta: 0.09% vs 0.005%
valor p: p=<0.01
BACKGROUND: There has been a recent surge in the literature highlighting the association of fentanyl as precipitating serotonin syndrome in patients on a serotonergic agent. OBJECTIVE: The purpose of our study was to understand the incidence of serotonin syndrome in patients who receive fentanyl while on serotonergic agents. STUDY DESIGN: This retrospective analysis was conducted from 2012 to 2013 after approval from the Institutional Review Board. We searched for all patients that had received a serotonergic agent and were admitted to the hospital during the study period. Next, we split these patients into 2 groups by placing all patients who had received fentanyl and a serotonergic agent into one group. We then searched for any of the Hunter Serotonin Toxicity Criteria in the records of patients that had received both fentanyl and a serotonergic agent. Further, we searched for all patients with serotonin syndrome mentioned in their records. SETTING: This study was conducted at a 900 bed tertiary care academic center. RESULTS: Over the 2 year study period, 112,045 patients were on a serotonergic agent, and 4,538 of these patients were treated with both fentanyl and a serotonergic agent. A search for Hunter's Criteria through the records of the patients receiving both fentanyl and a serotonergic agent revealed 23 patients had been documented with some of these symptoms. On detailed chart review, only 4 95% CI 1 - 10 of these patients truly met Hunter's Criteria for serotonin syndrome. We then searched all admissions for a diagnosis code of serotonin syndrome during the study period. Five additional cases of serotonin syndrome were found, but none of these patients were treated with fentanyl. LIMITATIONS: Some of the limitations of our study include that it represents a single institution, although it is a large academic center. An inherent limitation may be the under diagnosis of serotonin syndrome. CONCLUSION: The incidence of serotonin syndrome in patients who receive both fentanyl and a serotonergic agent is low.
Padma Gulur (Wed,) conducted a observational in Serotonin syndrome (n=112,045). Fentanyl vs. No fentanyl (serotonergic agents only) was evaluated on Incidence of serotonin syndrome (p=<0.01). The incidence of serotonin syndrome was significantly higher in patients receiving both fentanyl and a serotonergic agent (0.09%) compared to those on serotonergic agents alone (0.005%).