Serotonergic agents that can cause serotonin syndrome categorized into mechanisms

Table 16.2-4. Serotonergic agents that can cause serotonin syndrome categorized into mechanisms
Mechanism	Agents
Decreased serotonin breakdown	– MAOIs – Antibiotics: linezolid, tedizolid – Procarbazine
Decreased serotonin reuptake	– SSRIs: fluoxetine, fluvoxamine, paroxetine, citalopram, escitalopram, sertraline – SNRIs: venlafaxine, duloxetine, milnacipran – TCAs: clomipramine, imipramine, amitriptyline – Herbal: St John’s wort – Opioids: meperidine, buprenorphine, tramadol, tapentadol, dextromethorphan – Antiepileptics/mood stabilizers: valproate, carbamazepine – Antiemetics: ondansetron, metoclopramide
Increased serotonin precursors and agonists	– Tryptophan – Lithium carbonate – Fentanyl – LSD
Increased serotonin release	– Amphetamines – Cocaine – MDMA
Drug-drug interactions	– Inhibitors of CYP2D6 – Inhibitors of CYP3A4 – Antibiotics: erythromycin, ciprofloxacin – Antifungal: fluconazole – Antiretroviral: ritonavir
LSD, lysergic acid diethylamide; MAOI, monoamine oxidase inhibitor; MDMA, 3,4-methylenedioxy-N-methamphetamine; SNRI, serotonin-norepinephrine reuptake inhibitor; SSRI, selective serotonin reuptake inhibitor; TCA, tricyclic antidepressant.