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We report a patient who presented with classic serotonin syndrome (SS) after being started on milnacipran for fibromyalgia. To our knowledge, this is the first case of serotonin toxicity reported since milnacipran was approved by the Food and Drug Administration (FDA) for the treatment of fibromyalgia.
Level of evidence.
This is a case report describing a single patient treated for classic symptoms of serotonin toxicity with milnacipran, while on a chronic dose of paroxetine, and is therefore a Class IV study.
Case report.
A 76-year-old man with a history of chronic pain presented to the emergency room with progressive worsening of lethargy and confusion. The patient was initially noted by the family to be confused and asking the same questions repeatedly. Throughout the following 2 days, the patient became more confused and eventually severely dysarthric. He was ultimately brought to the emergency room after he was found on the floor lethargic with incomprehensible speech. The patient had a history of depression and had been on paroxetine, 25 mg daily, for 5 years. Eight days prior to this presentation, the patient had been diagnosed with fibromyalgia and started on milnacipran 50 mg twice daily, a newly approved medication for the treatment of fibromyalgia. On physical examination, the patient was found to have a temperature ranging from 100.5 …
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