It is important for providers to be aware of “red flag” symptoms associated with medication adverse events and to use every visit as an opportunity to do a quick check for potentially severe medication side effects, even if the visit is not medication focused. This is the first in a series of articles focused on identifying and addressing “red flag” symptoms.
Medication: Antidepressants (such as fluoxetine, sertraline and citalopram)
Concern: Serotonin Syndrome
Presentation: Triad Symptoms (mental status changes, neuromuscular and/or autonomic hyperactivity) – Usually appear rapidly, especially within 24 hours of starting new medications or dose increases.
| Mental Status Changes | Neuromuscular | Autonomic Hyperactivity |
| Agitation | Tremors | Rapid changes in blood pressure |
| Akathisia (excessive restlessness) | Hyperreflexia | Tachycardia |
| Anxiety | Slow continuous horizontal eye movements | Hyperthermia |
| Disorientation | “Babinski’s sign” | Flushed skin/sweating |
| Loss of consciousness | Dilated pupils |
| Severity | Presentation | Recommended Action |
| Mild | Tremors, hyperreflexia, mild agitation, mild anxiety | Patient should self monitor for any changes in symptoms. Provider should refer patient for immediate follow up assessment with the prescribing provider. |
| Moderate – Severe | Autonomic findings or moderate to severe mental status changes/neuromuscular changes, | Immediately refer patient to emergency care. |