Table 1.

Evidence supporting the key considerations for practice

CLINICAL CONSIDERATIONS	EVIDENCE RATING	REFERENCES
The best available evidence for the clinical presentation of toxicity is from the Hunter Area Toxicology Service in Australia	Level 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 combination	Level III^†	1,3
Some drugs thought to cause serotonin toxicity do not (eg, triptans, ondansetron)	Level III^†	1,4,7–11
Prevention of serotonin toxicity through good prescribing practices and monitoring is important	Level III^†	2,12

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.