Serotonin Syndrome with Tramadol and Dextromethorphan

Serotonin syndrome is an iatrogenic drug-induced synaptic serotonin concentration related toxidrome. A 29-year-old man developed agitation, tachycardia and myoclonus of limbs after an intramuscular injection of 100 mg tramadol. He had recently been given multiple medications, including dextromethorphan (DXM) by a private doctor for flu-like symptoms. The patient was stabilised with diazepam, midazolam and supportive treatment. Both tramadol and...