Serotonin Syndrome from Combination Hydrocodone and Cyclobenzaprine in a Patient with Cerebral Palsy

Abstract

Aim: Serotonin syndrome (SS) is a life-threatening syndrome that occurs with the use of serotonergic drugs, most commonly due to two or more agents. Cerebral palsy is associated with mood disorders, and more commonly pain, with a prevalence of up to 50–80%. Case presentation: A 58-year-old female with cerebral palsy, metastatic malignancy and mood disorder who presented to the emergency department with acute-on-chronic pain, and signs of SS. She was initiated on iv. dilaudid, titrated off oral medications and scheduled for a left-sided sacroiliac joint injection. Results: It was suspected that due to additional doses of hydrocodone and cyclobenzaprine, she developed moderate-SS. Conclusion: Physicians need to be cognizant of comorbidities and uncommon pain medications that can predispose patients to SS.

Keywords::

• cancer pain
• cerebral palsy
• chronic pain
• cyclobenzaprine
• hydrocodone
• opioids
• pain
• serotonin syndrome

Author contributions

V Bansal: contributions meet authorship criteria (a), (b), (c) and (d) as outlined in the Author Disclosure Form. M Aranke: contributions meet authorship criteria (a), (b), (c) and (d) as outlined in the Author Disclosure Form. P Vu: contributions meet authorship criteria (a), (b), (c) and (d) as outlined in the Author Disclosure Form. S Javed: contributions meet authorship criteria (a), (b), (c) and (d) as outlined in the Author Disclosure Form.

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Informed consent disclosure

The authors state that they have obtained appropriate institutional review board approval for this study protocol. Since this was a retrospectives chart review, a waiver of consent (a waiver of authorization) was obtained due to the retrospective nature of this review, involving no diagnostic or therapeutic intervention and no direct contact with the patients. Obtaining consent from these patients would have been impracticable as they are lost to follow-up, no longer in treatment or deceased.