Activate Now
 
ProHealth health Vitamin and Natural Supplement Store and Health
Home  |  Log In  |  My Account  |  View Cart  View Your ProHealth Vitamin and Supplement Shopping Cart
800-366-6056  |  Contact Us  |  Help

Fibromyalgia  Chronic Fatigue Syndrome & M.E.  Natural Wellness  Supplement News  Forums  Our Story
Store     Brands   |   A-Z Index   |   Best Sellers   |   New Products   |   Deals & Specials   |   Under $10   |   SmartSavings Club

Trending News

Social Anxiety Disorder Linked to High Serotonin Levels, Throwing Treatment with SSRIs into Serious ...

Therapeutic Effects and Mechanisms of Action of Rifaximin in Gastrointestinal Diseases

Promoting Optimal Nutrition with Digestive Enzymes

Immune response to a flu vaccine yields new insights into narcolepsy

Children with Lyme Disease

Health Benefits of Ginseng

7-Keto DHEA The Fat-Burning Metabolite of DHEA

Nutritional Strategies for Preventing Age-Related Vision Loss

Depersonalization and Derealization From Chronic Lyme Disease and Its Coinfections: A perpetual ment...

20 Health Benefits of Thyme Oil

 
Print Page
Email Article

Milnacipran-Associated Morbilliform Rash and Serotonin Toxicity

  [ 1 vote ]   [ Discuss This Article ]
www.ProHealth.com • July 19, 2013


Editor's comment: Although rare, a morbilliform rash and/or serotonin toxicity can be serious side effects of milnacipran (Savella).  A morbilliform rash is one that has a flat reddish base with a raised eruption in the center, resembling measles.  Serotonin toxicity (also called Serotonin Syndrome) is a potentially life-threatening condition resulting from elevated levels of serotonin, usually due to ingestion of two or more drugs (for example, MAOIs, SSRIs) that interfere with serotonin metabolism at different points.  The following abstract is a case study of a patient who developed a morbilliform rash and serotonin toxicity after adding milnacipran to the medications she was already taking. 

Occurrence of milnacipran-associated morbilliform rash and serotonin toxicity.

By Amanda M. Huskey, Cassandra C. Thomas, and James Aubrey Waddell

Abstract:

OBJECTIVE: To report the development of morbilliform rash and serotonin toxicity after the addition of milnacipran to a patient's medication therapy.

CASE SUMMARY: A 57-year-old white female presented to the emergency department because of a full-body morbilliform rash, which appeared 9 days after initiation of milnacipran 50 mg twice daily. In the emergency department the patient's vital signs were: heart rate 121 beats/min, blood pressure 180/100 mm Hg, and temperature 38.9 °C. The patient reported diarrhea, nausea, dizziness, restlessness, and increased muscle pain.

Her history included recurrent breast cancer first diagnosed in 1999, hypertension, fibromyalgia, depression, osteopenia, gastroesophageal reflux disease, insomnia, and endometriosis. Her home medications included milnacipran, fluoxetine, alprazolam, zolpidem, zoledronic acid, anastrozole, doxepin, ranitidine, levocetirizine, doxazosin, tramadol, vitamin D, and ferrous gluconate.  The patient's increased heart rate, blood pressure, and temperature, as well as restlessness, self-reported diarrhea and nausea, and self-reported increase in muscle pain, indicated serotonin toxicity.

Milnacipran, fluoxetine, and tramadol were discontinued, while doxepin was continued. Treatment consisted of acetaminophen, diphenhydramine, methylprednisolone, promethazine, and hydralazine 10 mg intravenously. The following morning all vital signs were within normal limits and the patient's diarrhea, nausea, dizziness, restlessness, and muscle pain resolved. She was discharged the following morning. The rash had resolved after day 2 of hospital discharge, which was the fourth day after discontinuation of milnacipran.

DISCUSSION: Given the patient's symptoms, the timing of symptom onset, the patient's history, and findings on physical examination, as well as use of the Naranjo probability scale, milnacipran was deemed the probable cause of the morbilliform reaction and serotonin toxicity. Only 1 case report of rash and 2 case reports of serotonin syndrome associated with milnacipran have been reported.

CONCLUSIONS: It is important to increase awareness of the possibility of developing morbilliform rash and serotonin toxicity with milnacipran therapy, as both conditions can be associated with poor outcomes if not detected early and treated appropriately.

Source: The Annals of Pharmacotherapy, July 2013. By Amanda M. Huskey, Cassandra C. Thomas, and James Aubrey Waddell. PharmD Student, College of Pharmacy, University of Tennessee, Knoxville, TN.



Please Discuss This Article:   Post a Comment 



[ Be the first to comment on this article ]




 
Free Chronic Fatigue Syndrome and Fibromyalgia Newsletters
Subscribe to
Our FREE
Newsletter
Subscribe Now!
Receive up-to-date ME/CFS & Fibromyalgia treatment and research news
 Privacy Guaranteed  |  View Archives

Save on Nutritional Supplement Orders

Featured Products

Energy NADH™ 12.5mg Energy NADH™ 12.5mg
Improve Energy & Cognitive Function
Ultra EPA  - Fish Oil Ultra EPA - Fish Oil
Ultra concentrated source of essential fish oils
FibroSleep™ FibroSleep™
The All-in-One Natural Sleep Aid
Ultra ATP+, Double Strength Ultra ATP+, Double Strength
Get energized with malic acid & magnesium
Mitochondria Ignite™ with NT Factor® Mitochondria Ignite™ with NT Factor®
Reduce Fatigue up to 45%

Natural Remedies

Soothe, Heal and Regulate Your Digestive System with Nutrient-Rich Aloe Vera Soothe, Heal and Regulate Your Digestive System with Nutrient-Rich Aloe Vera
Priming Your Immune System for Cold & Flu Season Priming Your Immune System for Cold & Flu Season
SAM-e: a Hard-Working Molecule that May Help Ease Pain & Brighten Mood SAM-e: a Hard-Working Molecule that May Help Ease Pain & Brighten Mood
Are You Obtaining the Proper Enzymes? Are You Obtaining the Proper Enzymes?
Aching Muscles? Top 10 Nutrients to Take Back Your Life Aching Muscles? Top 10 Nutrients to Take Back Your Life

FIBROMYALGIA RESOURCES
What is Fibromyalgia?
Fibromyalgia Diagnosis
Fibromyalgia Symptoms
Fibromyalgia Treatments
| CFS RESOURCES
What is CFS?
ME/CFS Diagnosis
ME/CFS Symptoms
ME/CFS Treatments
| FORUMS
Fibromyalgia
ME/CFS
ADVANCED MEDICAL LABS
WHOLESALE  |  AFFILIATES
GUARANTEE  |  PRIVACY
CONTACT US
LIBRARY
RSS
SITE MAP
ProHealth on Facebook  ProHealth on Twitter  ProHealth on Pinterest  ProHealth on Google Plus
Credit Card Processing