Table 1.

Evidence supporting the key considerations for practice

The best available evidence for the clinical presentation of toxicity is from the Hunter Area Toxicology Service in AustraliaLevel II*1
Serotonin toxicity most often happens when 2 serotonin-elevating drugs are used together. The use of an MAOI with an SSRI, an SNRI, or another MAOI is the most concerning drug combinationLevel III1,3
Some drugs thought to cause serotonin toxicity do not (eg, triptans, ondansetron)Level III1,4,711
Prevention of serotonin toxicity through good prescribing practices and monitoring is importantLevel III2,12
  • MAOI—monoamine oxidase inhibitor, SNRI—serotonin-norepinephrine reuptake inhibitor, SSRI—selective serotonin reuptake inhibitor.

  • * Level II: Comparison trials other than randomized controlled trials, systematic reviews, or meta-analyses; non-randomized, cohort, case-control, or epidemiologic studies; and preferably more than 1 study.

  • Level III: Expert opinion or consensus statements.