Key result
Co-administering escitalopram and dextromethorphan-promethazine linked to reversible serotonin syndrome and QTc prolongation.
Why the study?
Serotonin syndrome caused by drug interaction between escitalopram and dextromethorphan is a clinical concern requiring detailed case description.
Case Report (n=1)
Co-administration of escitalopram and dextromethorphan can cause serotonin syndrome and QTc prolongation, which resolves upon discontinuation of the offending agents.
Answers are grounded in this paper and cite their sources.
Supports caution with escitalopram-dextromethorphan co-use; leaves open incidence and risk stratification.
A 63-year-old woman with a history of long-standing depression, maintained on escitalopram, presented with altered mental status. Patient had recently been prescribed dextromethorphan-promethazine cough syrup 2 weeks prior for an upper respiratory tract infection. On admission, she was lethargic and obtunded and found to have inducible myoclonus on examination. The rest of her physical exam was unremarkable. Pertinent lab and imaging findings showed QTc prolongation on ECG, negative electroencephalogram and CT head findings, essentially normal blood tests and a negative toxicology screen. The patient was admitted to the step down unit for close observation; both escitalopram and the cough syrup were suspended and was supportively managed. Overnight the patient's mental status improved and the serial EcGs showed resolution of the prolonged QTc. Patient was discharged home without further complication.
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Dy et al. (2017) conducted a case report in Serotonin syndrome (n=1). Escitalopram and dextromethorphan was evaluated. Co-administration of escitalopram and dextromethorphan-promethazine resulted in serotonin syndrome with altered mental status and QTc prolongation, which resolved upon discontinuation.
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