961:(FDA) issued an alert suggesting that the combined use of either SSRIs or SNRIs with triptan medications or sibutramine could potentially lead to severe cases of SS. This has been disputed by other researchers, as none of the cases reported by the FDA met the Hunter criteria for SS. The condition has however occurred in surprising clinical situations, and because of phenotypic variations among individuals, it has been associated with unexpected drugs, including mirtazapine.
47:
6989:
7013:
1272:(with a regimen of 12 mg for the initial dose followed by 2 mg every 2 hours until clinical, while some claim that a higher initial dose up to 32mg has more benefit), and supportive care including the control of agitation, the control of autonomic instability, and the control of hyperthermia. Additionally, those who ingest large doses of serotonergic agents may benefit from gastrointestinal decontamination with
7001:
1452:
441:
1338:, so if care is taken to prevent an unsafe spike in body temperature or metabolic acidosis, oxygenation will assist in dispatching the excess serotonin. The same principle applies to alcohol intoxication. In cases of SS caused by MAOIs, oxygenation will not help to dispatch serotonin. In such instances, hydration is the main concern until the enzyme is regenerated.
1286:
demonstrating its efficacy for SS. Despite the absence of controlled trials, there are a number of case reports detailing apparent improvement after people have been administered cyproheptadine. Animal experiments also suggest a benefit from serotonin antagonists. Cyproheptadine is only available as
1096:
is the effect of progressive elevation of serotonin, either by raising the dose of one drug, or combining it with another serotonergic drug which may produce large elevations in serotonin levels. Some experts prefer the terms serotonin toxicity or serotonin toxidrome, to more accurately reflect that
1217:
develop. However, they are actually very different conditions with different underlying dysfunction (serotonin excess vs dopamine blockade). Both the time course and the clinical features of NMS differ significantly from those of serotonin toxicity. Serotonin toxicity has a rapid onset after the
1109:
There is no specific test for SS. Diagnosis is by symptom observation and investigation of the person's history. Several criteria have been proposed. The first evaluated criteria were introduced in 1991 by Harvey
Sternbach. Researchers later developed the Hunter Toxicity Criteria Decision Rules,
1281:
for myoclonus, and waiting for the symptoms to resolve. Moderate cases should have all thermal and cardiorespiratory abnormalities corrected and can benefit from serotonin antagonists. The serotonin antagonist cyproheptadine is the recommended initial therapy, although there have been no
443:
956:
has no significant serotonergic effects and is therefore not a dual action drug. Bupropion has also been suggested to cause SS, although as there is no evidence that it has any significant serotonergic activity, it is thought unlikely to produce the syndrome. In 2006 the US
447:
446:
442:
1276:
if it can be administered within an hour of overdose. The intensity of therapy depends on the severity of symptoms. If the symptoms are mild, treatment may only consist of discontinuation of the offending medication or medications, offering supportive measures, giving
448:
1015:. SS caused by tramadol can be particularly problematic if an individual taking the drug is unaware of the risks associated with it and attempts to self-medicate symptoms such as headache, agitation, and tremors with more opioids, further exacerbating the condition.
1133:, the size and reactivity of the pupils, the intensity of bowel sounds, skin color, and the presence or absence of sweating. The patient's history also plays an important role in diagnosis, investigations should include inquiries about the use of prescription and
1346:
Specific treatment for some symptoms may be required. One of the most important treatments is the control of agitation due to the extreme possibility of injury to the person themselves or caregivers, benzodiazepines should be administered at first sign of this.
1291:; it is unlikely to be effective in people administered activated charcoal and has limited use in severe cases. Cyproheptadine can be stopped when the person is no longer experiencing symptoms and the half life of serotonergic medications already passed.
964:
The relative risk and severity of serotonergic side effects and serotonin toxicity, with individual drugs and combinations, is complex. SS has been reported in patients of all ages, including the elderly, children, and even newborn infants due to
445:
1027:
involved in multiple complex biological processes including aggression, pain, sleep, appetite, anxiety, depression, migraine, and vomiting. In humans the effects of excess serotonin were first noted in 1960 in patients receiving an MAOI and
3303:
Laine K, Heikkinen T, Ekblad U, Kero P (July 2003). "Effects of exposure to selective serotonin reuptake inhibitors during pregnancy on serotonergic symptoms in newborns and cord blood monoamine and prolactin concentrations".
4857:
945:. It can take at least four weeks for this enzyme to be replaced by the body in the instance of irreversible inhibitors. With respect to tricyclic antidepressants, only clomipramine and imipramine have a risk of causing SS.
916:
Many cases of serotonin toxicity occur in people who have ingested drug combinations that synergistically increase synaptic serotonin. It may also occur due to an overdose of a single serotonergic agent. The combination of
1430:
Epidemiological studies of SS are difficult as many physicians are unaware of the diagnosis or they may miss the syndrome due to its variable manifestations. In 1998 a survey conducted in
England found that 85% of the
5027:
5012:
1092:
A postulated "spectrum concept" of serotonin toxicity emphasises the role that progressively increasing serotonin levels play in mediating the clinical picture as side effects merge into toxicity. The
1330:
should be avoided as they may lead to hypotension and shock. The cause of serotonin toxicity or accumulation is an important factor in determining the course of treatment. Serotonin is catabolized by
4537:
Nisijima K, Yoshino T, Yui K, Katoh S (January 2001). "Potent serotonin (5-HT)(2A) receptor antagonists completely prevent the development of hyperthermia in an animal model of the 5-HT syndrome".
1443:
study identified an incidence of 0.4 cases per 1000 patient-months for patients who were taking nefazodone. Additionally, around 14–16% of persons who overdose on SSRIs are thought to develop SS.
1482:. She had an ongoing history of depression, and came to the Manhattan hospital on the evening of March 4, 1984, with a fever, agitation and "strange jerking motions" of her body. She also seemed
523:. Severe symptoms include severe increases in heart rate and blood pressure. Temperature may rise to above 41.1 °C (106.0 °F) in life-threatening cases. Other abnormalities include
424:
measures may be needed. The number of cases of SS that occur each year is unclear. With appropriate medical intervention the risk of death is low, likely less than 1%. The high-profile
1439:
were unaware of SS. The incidence may be increasing as a larger number of pro-serotonergic drugs (drugs which increase serotonin levels) are now being used in clinical practice. One
5589:
444:
1068:
interaction in which increased synaptic concentrations of a serotonin agonist saturate all receptor subtypes. Additionally, noradrenergic CNS hyperactivity may play a role as CNS
1114:, 84% and 97%, respectively, when compared with the gold standard of diagnosis by a medical toxicologist. As of 2007, Sternbach's criteria were still the most commonly used.
4667:
Chechani V (February 2002). "Serotonin syndrome presenting as hypotonic coma and apnea: potentially fatal complications of selective serotonin receptor inhibitor therapy".
5975:
5970:
4847:
5987:
5965:
616:
Numerous medications and street drugs can cause SS when taken alone at high doses or in combination with other serotonergic agents. The table below lists some of these.
479:. (Many of these symptoms may be side effects of the drug or drug interaction causing excessive levels of serotonin rather than an effect of elevated serotonin itself.)
969:
exposure. The serotonergic toxicity of SSRIs increases with dose, but even in overdose, it is insufficient to cause fatalities from SS in healthy adults. Elevations of
3888:
Whyte I, Dawson A, Buckley N (2003). "Relative toxicity of venlafaxine and selective serotonin reuptake inhibitors in overdose compared to tricyclic antidepressants".
6956:
5138:
3187:
Wenzel RG, Tepper S, Korab WE, Freitag F (November 2008). "Serotonin syndrome risks when combining SSRI/SNRI drugs and triptans: is the FDA's alert warranted?".
1302:. Critically ill people should receive the above therapies as well as sedation or neuromuscular paralysis. People who have autonomic instability such as low
1209:(NMS). The clinical features of neuroleptic malignant syndrome and SS share some features which can make differentiating them difficult. In both conditions,
4005:
1375:
Treatment for hyperthermia includes reducing muscle overactivity via sedation with a benzodiazepine. More severe cases may require muscular paralysis with
40:
Serotonin toxicity, serotonin toxidrome, serotonin sickness, serotonin storm, serotonin poisoning, hyperserotonemia, serotonergic syndrome, serotonin shock
4949:
6381:
3552:
Vuori E, Henry J, Ojanperä I, Nieminen R, Savolainen T, Wahlsten P, Jäntti M (2003). "Death following ingestion of MDMA (ecstasy) and moclobemide".
1294:
Additional pharmacological treatment for severe case includes administering atypical antipsychotic drugs with serotonin antagonist activity such as
933:
pose a particularly acute risk of life-threatening serotonin syndrome. The case of combination of MAOIs with tryptamine agonists (commonly known as
6068:
5334:
1682:
1008:. Nonetheless, it is not uncommon for individuals taking opioids to also be taking antidepressants due to the comorbidity of pain and depression.
2020:
7060:
5329:
2359:
2149:
1387:
is not recommended for muscular paralysis as it may increase the risk of cardiac dysrhythmia from hyperkalemia associated with rhabdomyolysis.
1363:. The agitation can cause a large amount of muscle breakdown. This breakdown can cause severe damage to the kidneys through a condition called
2330:
1502:, commonly referred to as interns or residents, in hospital training programs, and they also now require closer senior physician supervision.
1080:
have been suggested as affecting the development of the syndrome. Serotonin toxicity is more pronounced following supra-therapeutic doses and
1411:
may persist for a number of days. Symptoms typically persist for a longer time frame in patients taking drugs which have a long elimination
5131:
1886:
1072:
concentrations are increased in SS and levels appear to correlate with the clinical outcome. Other neurotransmitters may also play a role;
958:
1498:. A medical intern prescribed the pethidine. The case influenced graduate medical education and residency work hours. Limits were set on
1012:
977:
are mixed together. Various drugs, other than SSRIs, also have clinically significant potency as serotonin reuptake inhibitors, (such as
647:
311:
124:
2666:
1933:
Brensilver JM, Smith L, Lyttle CS (September 1998). "Impact of the Libby Zion case on graduate medical education in internal medicine".
6927:
2967:
Gillman P (2006). "A systematic review of the serotonergic effects of mirtazapine in humans: implications for its dual action status".
2502:
2352:"Adderall (Amphetamine, Dextroamphetamine Mixed Salts) Drug Information: Side Effects and Drug Interactions – Prescribing Information"
5957:
3638:"Opioid-induced Inhibition of the Human 5-HT and Noradrenaline Transporters in Vitro: Link to Clinical Reports of Serotonin Syndrome"
1422:
may contribute to ongoing features. Following appropriate medical management, SS is generally associated with a favorable prognosis.
4914:
385:
Diagnosis is based on a person's symptoms and history of medication use. Other conditions that can produce similar symptoms such as
4922:
937:) can present similar dangers as their combination with precursors, but this phenomenon has been described in general terms as the
4584:
3474:
Isbister G, Bowe S, Dawson A, Whyte I (2004). "Relative toxicity of selective serotonin reuptake inhibitors (SSRIs) in overdose".
5947:
5124:
1141:, as all these agents have been implicated in the development of SS. To fulfill the Hunter Criteria, a patient must have taken a
2459:
Braun U, Kalbhen DA (October 1973). "Evidence for the
Biogenic Formation of Amphetamine Derivatives from Components of Nutmeg".
952:
in SS, but it appears based on their pharmacology that they are unlikely to cause the syndrome. It has also been suggested that
5927:
5600:
3813:
Oates JA, Sjoerdsma A (December 1960). "Neurologic effects of tryptophan in patients receiving a monoamine oxidase inhibitor".
2255:
1359:
and hyperthermia. If physical restraints are necessary for severe agitation they must be rapidly replaced with pharmacological
643:
540:
307:
120:
3961:
Gillman PK (June 2006). "A review of serotonin toxicity data: implications for the mechanisms of antidepressant drug action".
5952:
5584:
3872:
6061:
5790:
5778:
5240:
3148:"The FDA alert on serotonin syndrome with combined use of SSRIs or SNRIs and Triptans: an analysis of the 29 case reports"
2447:
Mechanisms of serotonergic drugs implicated in serotonin syndrome ... Stimulation of serotonin receptors ... LSD
459:
Symptom onset is usually relatively rapid, SS encompasses a wide range of clinical findings. Mild symptoms may consist of
1052:
was responsible for the development of the syndrome. Further study has determined that overstimulation of primarily the
6009:
5942:
5497:
2323:"Vyvanse (Lisdexamfetamine Dimesylate) Drug Information: Side Effects and Drug Interactions – Prescribing Information"
6498:
5712:
5515:
4160:
4099:
2870:
2567:
Steinberg M, Morin AK (January 2007). "Mild serotonin syndrome associated with concurrent linezolid and fluoxetine".
1914:
1665:
1559:
306:
Serotonin syndrome is typically caused by the use of two or more serotonergic medications or drugs. This may include
2682:"Methylene blue and serotonin toxicity: inhibition of monoamine oxidase A (MAO A) confirms a theoretical prediction"
7017:
6812:
1011:
Cases where opioids alone are the cause of SS are typically seen with tramadol, because of its dual mechanism as a
1487:
6054:
5831:
3642:
3268:
1407:
Upon the discontinuation of serotonergic drugs, most cases of SS resolve within 24 hours, although in some cases
790:
4041:
3434:
Gill M, LoVecchio F, Selden B (April 1999). "Serotonin syndrome in a child after a single dose of fluvoxamine".
1486:
at times. The emergency room physicians were unable to diagnose her condition definitively but admitted her for
7050:
6630:
6625:
5346:
5322:
5152:
1851:
1479:
1206:
948:
Many medications may have been incorrectly thought to cause SS. For example, some case reports have implicated
386:
182:
4946:
2411:(Report). World Health Organisation – Expert Committee on Drug Dependence (published 2014-06-20). 20 June 2014
2181:
Isenberg D, Wong SC, Curtis JA (September 2008). "Serotonin syndrome triggered by a single dose of suboxone".
2049:"The Hunter Serotonin Toxicity Criteria: simple and accurate diagnostic decision rules for serotonin toxicity"
1681:
New, Andrea M.; Nelson, Sarah; Leung, Jonathan G. (2015-10-01). Alexander, Earnest; Susla, Gregory M. (eds.).
428:, who is generally accepted to have died from SS, resulted in changes to graduate medical school education in
408:
Initial treatment consists of discontinuing medications which may be contributing. In those who are agitated,
6897:
6635:
6323:
6025:
5910:
5826:
5768:
5538:
5317:
1419:
715:
20:
6453:
5994:
5368:
1205:
toxicity, or worsening psychiatric condition. The condition most often confused with serotonin syndrome is
2405:
7005:
6620:
5504:
1499:
1351:
are not recommended for agitation or delirium as they may contribute to mortality by enforcing isometric
1111:
918:
635:
315:
128:
255:. The symptoms can range from mild to severe, and are potentially fatal. Symptoms in mild cases include
7045:
6739:
6358:
5982:
5532:
5204:
1440:
1093:
798:
2778:
Sun-Edelstein C, Tepper SJ, Shapiro RE (September 2008). "Drug-induced serotonin syndrome: a review".
1264:
Management is based primarily on stopping the usage of the precipitating drugs, the administration of
6892:
6398:
6386:
6328:
5932:
5900:
5874:
5852:
5701:
5280:
4313:"Serotonin Syndrome: Pathophysiology, Clinical Features, Management, and Potential Future Directions"
1984:
743:
132:
4129:
2871:"A Review of Serotonin Toxicity Data: Implications for the Mechanisms of Antidepressant Drug Action"
2351:
2156:
1478:
at her death on March 5, 1984, at age 18. She died within 8 hours of her emergency admission to the
6887:
6808:
6610:
5999:
5773:
5187:
5042:
2322:
1210:
639:
575:
394:
319:
190:
4455:
Graudins A, Stearman A, Chan B (1998). "Treatment of the serotonin syndrome with cyproheptadine".
7055:
6937:
6558:
6468:
6272:
6004:
5937:
5693:
5511:
5363:
5353:
5197:
4878:
Asch DA, Parker RM (March 1988). "The Libby Zion case. One step forward or two steps backward?".
4082:
Nisijima K, Shioda K, Iwamura T (2007). "Neuroleptic malignant syndrome and serotonin syndrome".
1249:
1172:
Hypertonism plus temperature > 38 °C (100 °F) plus ocular clonus or inducible clonus
750:
323:
5116:
2527:
1855:
6282:
5869:
5861:
5816:
5492:
5464:
5312:
1727:
Boyer EW , Shannon M . The serotonin syndrome . N Engl J Med. 2005 ; 352 ( 11 ): 1112-1120
1655:
1549:
1241:
1230:
blockade (NMS) has a slow onset, typically evolves over several days after administration of a
993:
970:
949:
794:
600:
390:
379:
186:
177:
66:
5082:
4143:
Tormoehlen, LM; Rusyniak, DE (2018). "Neuroleptic malignant syndrome and serotonin syndrome".
3738:
2279:
Schep LJ, Slaughter RJ, Beasley DM (August 2010). "The clinical toxicology of metamfetamine".
1244:
may become difficult in patients recently exposed to both serotonergic and neuroleptic drugs.
1181:
Serotonin toxicity has a characteristic picture which is generally hard to confuse with other
1077:
6605:
6508:
6488:
5884:
5758:
5576:
5554:
5469:
5392:
5302:
5289:
5214:
5021:
4368:
Sporer K (1995). "The serotonin syndrome. Implicated drugs, pathophysiology and management".
2646:
1904:
1194:
1134:
1032:. The syndrome is caused by increased serotonin in the CNS. It was originally suspected that
997:
973:(CNS) serotonin will typically only reach potentially fatal levels when drugs with different
520:
252:
1218:
administration of a serotonergic drug and responds to serotonin blockade such as drugs like
495:. Moderate intoxication includes additional abnormalities such as hyperactive bowel sounds,
6850:
6463:
6448:
6264:
5821:
5638:
5527:
2602:
Karki SD, Masood GR (2003). "Combination risperidone and SSRI-induced serotonin syndrome".
2494:
1432:
1265:
1122:
858:
460:
413:
8:
6993:
6932:
6656:
6615:
6422:
6375:
6318:
6143:
6117:
5750:
5397:
5252:
5192:
5031:
1331:
974:
929:
871:
496:
350:
256:
4580:
4288:
4253:
3010:
Munhoz RP (2004). "Serotonin syndrome induced by a combination of bupropion and SSRIs".
996:, it is still possible for an individual to develop SS from certain opioids without the
6845:
6709:
6553:
6548:
6543:
6353:
6168:
5920:
5905:
5893:
5643:
5594:
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5294:
5182:
5036:
4983:
4820:
4803:
4784:
4735:
4692:
4562:
4519:
4429:
4412:
4393:
4345:
4312:
4152:
4117:
4033:
3986:
3838:
3790:
3765:
3715:
3688:
3664:
3637:
3613:
3588:
3534:
3499:
3411:
3386:
3362:
3345:
3212:
3164:
3147:
3120:
3095:
3071:
3046:
3023:
2992:
2949:
2906:
2851:
2803:
2755:
2734:
2706:
2681:
2627:
2304:
2256:"Does the Caffeine in Your Coffee, Tea, or Soft Drinks Interfere With Antidepressants?"
2012:
2000:
1626:
1609:
1511:
1475:
1352:
1273:
1182:
1142:
1138:
1126:
675:
667:
524:
492:
355:
77:
4550:
4468:
4091:
3447:
2544:
374:. It occurs in about 15% of SSRI overdoses. It is a predictable consequence of excess
6975:
6535:
6458:
6391:
6348:
6287:
6254:
6191:
6158:
6148:
6107:
5683:
5649:
5621:
5612:
5544:
5520:
5387:
5235:
5053:
4975:
4895:
4825:
4776:
4771:
4754:
4727:
4723:
4684:
4680:
4649:
4622:
4618:
4554:
4511:
4472:
4434:
4385:
4381:
4350:
4332:
4293:
4275:
4234:
4193:
4166:
4156:
4105:
4095:
4064:
4055:
Fennell J, Hussain M (2005). "Serotonin syndrome: case report and current concepts".
4025:
3978:
3940:
3936:
3905:
3868:
3830:
3795:
3720:
3669:
3618:
3569:
3565:
3538:
3491:
3451:
3416:
3367:
3321:
3285:
3247:
3230:
Duggal HS, Fetchko J (April 2002). "Serotonin syndrome and atypical antipsychotics".
3204:
3169:
3125:
3076:
3027:
2984:
2941:
2937:
2898:
2890:
2843:
2795:
2760:
2711:
2658:
2619:
2584:
2549:
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2438:
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2070:
2004:
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1702:
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1631:
1555:
1348:
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1227:
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810:
295:
can increase to greater than 41.1 °C (106.0 °F). Complications may include
167:
61:
6521:
6046:
4987:
4788:
4739:
4696:
4566:
4523:
4397:
4037:
3990:
3842:
3503:
3216:
2996:
2910:
2855:
2807:
2631:
2308:
2016:
6516:
6478:
6473:
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4967:
4887:
4815:
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4719:
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4614:
4546:
4503:
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4377:
4340:
4324:
4304:
4283:
4265:
4224:
4148:
4087:
4017:
3974:
3970:
3932:
3897:
3822:
3785:
3777:
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3700:
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3600:
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3526:
3483:
3443:
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3398:
3357:
3313:
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3196:
3159:
3115:
3107:
3066:
3058:
3019:
2976:
2933:
2924:
Isbister GK, Downes F, Whyte IM (April 2003). "Olanzapine and serotonin toxicity".
2886:
2882:
2835:
2787:
2750:
2701:
2693:
2611:
2576:
2539:
2468:
2288:
2228:
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2060:
1996:
1870:
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1621:
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1315:
1288:
1190:
1024:
876:
866:
727:
583:
562:
335:
292:
152:
2953:
1117:
The most important symptoms for diagnosing SS are tremor, extreme aggressiveness,
6695:
6483:
6403:
6201:
6183:
5728:
5419:
5104:
5047:
4953:
4311:
Scotton, William J; Hill, Lisa J; Williams, Adrian C; Barnes, Nicholas M (2019).
3705:
3243:
2292:
1698:
1356:
1202:
1198:
1185:, but in some situations it may go unrecognized because it may be mistaken for a
1130:
1065:
1053:
989:
758:
723:
503:; a temperature as high as 40 °C (104 °F). The overactive reflexes and
260:
4891:
3385:
Isbister GK, Dawson A, Whyte IM, Prior FH, Clancy C, Smith AJ (September 2001).
3281:
2232:
6902:
6875:
6798:
6765:
6700:
6440:
6206:
6153:
5785:
5734:
5562:
5271:
5148:
5058:
4852:
4507:
4270:
4229:
4212:
2730:
2194:
1364:
1303:
1278:
1269:
1223:
1219:
1069:
1005:
908:
896:
747:
630:
536:
528:
512:
468:
429:
425:
421:
417:
409:
367:
300:
284:
224:
220:
208:
140:
98:
3317:
3111:
3062:
7039:
6770:
6661:
6583:
6431:
6216:
6173:
6089:
5811:
5763:
5633:
5402:
5358:
5209:
4336:
4328:
4279:
4213:"Citalopram overdose, serotonin toxicity, or neuroleptic malignant syndrome?"
2894:
2791:
2219:
Gnanadesigan N, Espinoza RT, Smith RL (June 2005). "The serotonin syndrome".
1706:
1384:
1319:
1311:
1235:
1214:
1186:
1166:
1073:
1037:
938:
818:
769:
691:
604:
566:
476:
272:
86:
6277:
4004:
Hegerl U, Bottlender R, Gallinat J, Kuss HJ, Ackenheil M, Möller HJ (1998).
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3909:
3901:
3834:
3826:
3799:
3724:
3673:
3622:
3573:
3495:
3455:
3420:
3371:
3325:
3289:
3251:
3208:
3173:
3129:
3080:
3031:
2988:
2945:
2902:
2799:
2764:
2715:
2697:
2662:
2623:
2588:
2553:
2442:
2300:
2240:
2202:
2120:
2074:
2065:
2048:
2047:
Dunkley EJ, Isbister GK, Sibbritt D, Dawson AH, Whyte IM (September 2003).
2008:
1882:
1714:
1635:
1396:
1314:. Conversely, hypertension or tachycardia can be treated with short-acting
1253:
1245:
1153:
1045:
1000:. However, most cases of opioid-related SS involve the concurrent use of a
923:
785:
500:
344:
268:
82:
4899:
4755:"Serotonin syndrome. Presentation of 2 cases and review of the literature"
4476:
4389:
4029:
4021:
3604:
3530:
3487:
3402:
2847:
2839:
2480:
1946:
6866:
6830:
6791:
6777:
6704:
6676:
6135:
5266:
5227:
5169:
5077:
4971:
3781:
3387:"Neonatal paroxetine withdrawal syndrome or actually serotonin syndrome?"
1874:
1483:
1388:
1327:
1307:
1231:
982:
953:
892:
888:
880:
754:
739:
735:
731:
698:
687:
587:
464:
398:
194:
156:
136:
94:
6163:
4145:
Thermoregulation: From Basic
Neuroscience to Clinical Neurology, Part II
46:
6922:
6820:
6782:
6719:
6683:
6648:
6310:
5377:
5247:
5099:
4843:
2580:
1495:
1471:
1463:
1455:
1436:
1380:
1376:
1295:
1252:"lead pipe" rigidity are classically present in NMS, whereas SS causes
1029:
904:
884:
839:
814:
651:
508:
402:
215:
198:
70:
16:
Symptoms caused by an excess of serotonin in the central nervous system
5004:
3923:
Gillman PK (June 2004). "The spectrum concept of serotonin toxicity".
3655:
3200:
2615:
2472:
382:. Onset of symptoms is typically within a day of the extra serotonin.
6942:
6882:
6835:
6744:
6731:
6688:
6671:
6595:
6246:
6211:
6079:
5487:
5438:
5426:
5409:
5341:
5088:
2150:"Prescribing Practice Review 32: Managing depression in primary care"
1985:"Serotonin toxicity: a practical approach to diagnosis and treatment"
1491:
1412:
1299:
1118:
1098:
1001:
934:
900:
862:
854:
850:
706:
694:
679:
655:
579:
558:
550:
546:
The symptoms are often present as a clinical triad of abnormalities:
472:
375:
339:
327:
248:
144:
54:
4947:
Image demonstrating findings in moderately severe serotonin syndrome
2980:
1084:, and they merge in a continuum with the toxic effects of overdose.
405:
should be ruled out. No laboratory tests can confirm the diagnosis.
6840:
6825:
6758:
6748:
6666:
6340:
6084:
5962:
Spinal muscular atrophy with lower extremity predominance (SMALED)
5667:
5659:
5625:
5479:
5382:
4491:
4147:. Handbook of Clinical Neurology. Vol. 157. pp. 663–675.
2380:
1408:
1360:
1081:
978:
719:
683:
671:
595:
554:
516:
488:
331:
288:
280:
148:
102:
4804:"Serotonin syndrome: potentially fatal but difficult to recognize"
3517:
Whyte IM, Dawson AH (2002). "Redefining the serotonin syndrome ".
2495:"Erowid Yohimbe Vaults: Notes on Yohimbine by William White, 1994"
2093:
Ener RA, Meglathery SB, Van Decker WA, Gallagher RM (March 2003).
985:, and MDMA) and are associated with severe cases of the syndrome.
543:; these effects usually arising as a consequence of hyperthermia.
6961:
6870:
6587:
6232:
5146:
2092:
1323:
1033:
829:
778:
762:
532:
371:
359:
296:
160:
6960:
is generally non-toxic metal, but in large doses it can lead to
4252:
Prakash, Sanjay; Shah, Chetsi S.; Prakash, Anurag (2024-06-09).
3346:"Antidepressants and the serotonin syndrome in general practice"
1256:
and clonus; these distinct symptoms can aid in differentiation.
507:
in moderate cases may be greater in the lower limbs than in the
247:) is a group of symptoms that may occur with the use of certain
6957:
6753:
6714:
6102:
5706:
5447:
5414:
5016:
2144:
2142:
2140:
2138:
2136:
2134:
2132:
2130:
1335:
1287:
tablets and therefore can only be administered orally or via a
1162:
966:
843:
825:
662:
591:
504:
480:
452:
276:
90:
4710:
Haddad PM (2001). "Antidepressant discontinuation syndromes".
4086:. Progress in Brain Research. Vol. 162. pp. 81–104.
1306:
require treatment with direct-acting sympathomimetics such as
1060:
appears to contribute substantially to the condition. The 5-HT
6971:
6967:
6126:
2046:
1451:
805:
264:
4003:
3770:
Primary Care
Companion to the Journal of Clinical Psychiatry
3391:
Archives of
Disease in Childhood. Fetal and Neonatal Edition
2155:. National Prescribing Service Limited. 2005. Archived from
2127:
1459:
711:
570:
484:
363:
3687:
Bair MJ, Robinson RL, Katon W, Kroenke K (November 2003).
3551:
2777:
2647:"Serotonin syndrome caused by olanzapine and clomipramine"
1490:
and observation. Her death was caused by a combination of
1470:
The most widely recognized example of SS was the death of
1415:, active metabolites, or a protracted duration of action.
988:
Although the most significant health risk associated with
4310:
4006:"The serotonin syndrome scale: first results on validity"
2525:
2218:
4254:"Serotonin syndrome controversies: A need for consensus"
3867:. Philadelphia: Williams & Wilkins. pp. 103–6.
3686:
3384:
3302:
3186:
2728:
4536:
3473:
3469:
3467:
3465:
4958:
Boyer EW, Shannon M (2005). "The serotonin syndrome".
3689:"Depression and pain comorbidity: a literature review"
491:, whereas hyperreflexia is symptomatic of exposure to
6076:
4081:
3863:
Whyte, Ian M. (2004). "Serotonin
Toxicity/Syndrome".
3047:"Bupropion induced serotonin syndrome: a case report"
3044:
2406:
Alpha-methyltryptamine (AMT) – Critical Review Report
2278:
2095:"Serotonin syndrome and other serotonergic disorders"
1932:
1418:
Cases have reported persisting chronic symptoms, and
4994:
4454:
3462:
3045:
Thorpe EL, Pizon AF, Lynch MJ, Boyer J (June 2010).
2679:
2526:
Birmes P, Coppin D, Schmitt L, Lauque D (May 2003).
1983:
Isbister GK, Buckley NA, Whyte IM (September 2007).
1982:
1683:"Psychiatric Emergencies in the Intensive Care Unit"
1607:
420:
may be used. In those with a high body temperature,
4752:
4639:
4210:
4183:
3745:. The American Society of Health-System Pharmacists
3433:
2923:
2826:Sternbach H (June 1991). "The serotonin syndrome".
1978:
1976:
1660:. Lippincott Williams & Wilkins. p. 1124.
4410:
4251:
4211:Isbister GK, Dawson A, Whyte IM (September 2001).
4142:
3956:
3954:
3887:
3763:
3266:Gillman PK (June 2005). "The serotonin syndrome".
3096:"Bupropion, bayesian logic and serotonin toxicity"
2645:Verre M, Bossio F, Mammone A, et al. (2008).
2644:
2180:
1974:
1972:
1970:
1968:
1966:
1964:
1962:
1960:
1958:
1956:
4413:"Recognition and treatment of serotonin syndrome"
2429:Bijl D (October 2004). "The serotonin syndrome".
1121:, or clonus (spontaneous, inducible and ocular).
7037:
1554:. Elsevier Health Sciences. pp. 1154–1155.
1234:drug, and responds to dopamine agonists such as
475:(intermittent jerking or twitching), as well as
4915:"Doctors' Accounts Vary In Death of Libby Zion"
3951:
2214:
2212:
1953:
1159:Ocular clonus plus agitation or diaphoresis, or
4753:Mason PJ, Morris VA, Balcezak TJ (July 2000).
4054:
3812:
3680:
3343:
2566:
1680:
1391:agents are not recommended as the increase in
6430:
6062:
5132:
4801:
3766:"Serotonin Syndrome Associated With Tramadol"
3635:
3344:Mackay FJ, Dunn NR, Mann RD (November 1999).
3339:
3337:
3335:
3229:
2673:
1935:The Mount Sinai Journal of Medicine, New York
4957:
4317:International Journal of Tryptophan Research
3258:
3223:
3087:
3038:
3003:
2821:
2819:
2817:
2595:
2458:
2209:
1849:
1654:Domino, Frank J.; Baldor, Robert A. (2013).
1653:
1125:of the patient should include assessment of
5851:
4912:
4450:
4448:
3997:
3580:
3516:
2825:
2601:
1551:Ferri's Clinical Advisor 2017: 5 Books in 1
1013:serotonin-norepinephrine reuptake inhibitor
312:serotonin norepinephrine reuptake inhibitor
125:serotonin norepinephrine reuptake inhibitor
6069:
6055:
5139:
5125:
4877:
4666:
4640:Jaunay E, Gaillac V, Guelfi J (2001). "".
4492:"The serotonin syndrome and its treatment"
4489:
4136:
3960:
3922:
3757:
3519:Journal of Toxicology: Clinical Toxicology
3332:
3265:
3093:
2569:American Journal of Health-System Pharmacy
2042:
2040:
2038:
2036:
2034:
2032:
2030:
1909:. Cambridge University Press. p. 51.
1845:
1843:
1841:
1839:
1837:
1835:
1833:
1831:
1829:
1827:
1825:
1823:
1821:
1819:
1817:
1815:
1813:
1811:
1809:
1807:
1805:
1803:
1801:
1799:
1797:
1795:
1793:
1791:
1789:
1787:
1785:
1783:
1781:
1779:
1777:
1775:
1773:
1771:
1769:
1767:
1765:
1763:
1761:
1759:
1757:
1755:
1753:
1603:
1601:
1599:
1597:
1595:
1593:
1591:
1145:and meet one of the following conditions:
412:may be used. If this is not sufficient, a
45:
4819:
4770:
4709:
4428:
4344:
4287:
4269:
4228:
3789:
3714:
3704:
3663:
3612:
3589:"Management of opioid analgesic overdose"
3410:
3361:
3163:
3119:
3070:
3009:
2966:
2814:
2754:
2705:
2680:Ramsay RR, Dunford C, Gillman PK (2007).
2543:
2521:
2519:
2110:
2064:
1928:
1926:
1751:
1749:
1747:
1745:
1743:
1741:
1739:
1737:
1735:
1733:
1649:
1647:
1645:
1625:
1608:Volpi-Abadie J, Kaye AM, Kaye AD (2013).
1589:
1587:
1585:
1583:
1581:
1579:
1577:
1575:
1573:
1571:
1543:
1541:
1539:
1537:
1535:
1533:
1531:
1529:
1527:
1176:
625:Drugs that can induce serotonin syndrome
4604:
4445:
4367:
3858:
3856:
3854:
3852:
3731:
3145:
3141:
3139:
1902:
1480:New York Hospital Cornell Medical Center
1450:
1129:and muscle rigidity, the dryness of the
1064:receptor may still contribute through a
455:seen in a person with serotonin syndrome
439:
4848:"A Mix of Medicines That Can Be Lethal"
4605:Prator B (2006). "Serotonin syndrome".
4258:World Journal of Critical Care Medicine
2868:
2088:
2086:
2084:
2027:
1500:working hours for medical postgraduates
1435:that had prescribed the antidepressant
603:effects: myoclonus (muscle twitching),
7038:
5928:Distal hereditary motor neuronopathies
5601:Template:Demyelinating diseases of CNS
4860:from the original on November 13, 2013
4802:Sampson E, Warner JP (November 1999).
4323:. SAGE Publications: 117864691987392.
4184:Christensen V, Glenthøj B (2001). "".
2516:
2428:
2253:
2183:American Journal of Emergency Medicine
1923:
1896:
1730:
1642:
1568:
1524:
541:disseminated intravascular coagulation
308:selective serotonin reuptake inhibitor
121:Selective serotonin reuptake inhibitor
7061:Adverse effects of psychoactive drugs
6050:
5120:
4842:
3862:
3849:
3586:
3136:
2926:Psychiatry and Clinical Neurosciences
2735:"Demystifying serotonin syndrome (or
2638:
2272:
1906:Medication-Induced Movement Disorders
1547:
435:
267:. Symptoms in moderate cases include
7000:
5779:Idiopathic intracranial hypertension
5168:
4925:from the original on August 16, 2009
4581:"Serotonin syndrome – PubMed Health"
4245:
2733:, Patel T, Kellar J (October 2018).
2528:"Serotonin syndrome: a brief review"
2247:
2081:
172:Based on symptoms and medication use
7012:
3593:The New England Journal of Medicine
1863:The New England Journal of Medicine
1399:temperature set point abnormality.
1395:is due to muscular activity, not a
1152:Inducible clonus plus agitation or
1087:
13:
6010:Infantile progressive bulbar palsy
4153:10.1016/B978-0-444-64074-1.00039-2
3764:Takeshita J, Litzinger MH (2009).
3636:Rickli, Anna; et al. (2018).
3024:10.1097/01.wnf.0000142754.46045.8c
2001:10.5694/j.1326-5377.2007.tb01282.x
1657:The 5-Minute Clinical Consult 2014
1018:
941:. Many MAOIs irreversibly inhibit
14:
7072:
5713:Template:Cerebrovascular diseases
5516:Frontotemporal lobar degeneration
4940:
4010:Eur Arch Psychiatry Clin Neurosci
7011:
6999:
6988:
6987:
5733:For more detailed coverage, see
5711:For more detailed coverage, see
5682:For more detailed coverage, see
5648:For more detailed coverage, see
5599:For more detailed coverage, see
4772:10.1097/00005792-200007000-00001
4724:10.2165/00002018-200124030-00003
4681:10.1097/00003246-200202000-00033
4619:10.1097/01376517-200604000-00005
4382:10.2165/00002018-199513020-00004
3937:10.1111/j.1526-4637.2004.04033.x
3566:10.1046/j.1360-0443.2003.00292.x
2938:10.1046/j.1440-1819.2003.01110.x
2669:from the original on 2009-01-08.
2254:Taylor, Marygrace (2009-05-12).
2112:10.1046/j.1526-4637.2003.03005.x
2023:from the original on 2009-04-12.
1892:from the original on 2013-06-18.
1474:in 1984. Zion was a freshman at
1446:
1355:that are associated with severe
921:(MAOIs) with precursors such as
4913:Jan Hoffman (January 1, 1995).
4906:
4871:
4836:
4795:
4746:
4703:
4660:
4633:
4598:
4587:from the original on 2013-02-01
4573:
4530:
4483:
4404:
4361:
4204:
4177:
4075:
4048:
3916:
3881:
3806:
3643:British Journal of Pharmacology
3629:
3545:
3510:
3427:
3378:
3296:
3269:New England Journal of Medicine
3180:
2960:
2917:
2862:
2771:
2722:
2560:
2505:from the original on 2013-01-26
2487:
2452:
2431:Netherlands Journal of Medicine
2422:
2398:
2373:
2362:from the original on 2017-03-23
2344:
2333:from the original on 2017-03-25
2315:
2221:New England Journal of Medicine
2174:
1462:which contributed to SS in the
1425:
1370:
791:5-Methoxy-diisopropyltryptamine
3975:10.1016/j.biopsych.2005.11.016
3306:Archives of General Psychiatry
3232:American Journal of Psychiatry
2887:10.1016/j.biopsych.2005.11.016
2869:Gillman, P. Ken (2006-06-01).
2828:American Journal of Psychiatry
1721:
1674:
1420:antidepressant discontinuation
1383:, and artificial ventilation.
1326:; longer acting drugs such as
1207:neuroleptic malignant syndrome
607:(manifested by clonus), tremor
387:neuroleptic malignant syndrome
183:Neuroleptic malignant syndrome
1:
6026:Amyotrophic lateral sclerosis
5911:Hereditary spastic paraplegia
5769:Normal pressure hydrocephalus
4551:10.1016/S0006-8993(00)03020-1
4469:10.1016/S0736-4679(98)00057-2
4092:10.1016/S0079-6123(06)62006-2
3693:Archives of Internal Medicine
3448:10.1016/S0196-0644(99)70313-6
3264:Boyer and Shannon's reply to
3100:Journal of Medical Toxicology
3051:Journal of Medical Toxicology
2780:Expert Opinion on Drug Safety
1517:
1259:
21:SSRI discontinuation syndrome
5995:Progressive muscular atrophy
4084:Neurobiology of Hyperthermia
3706:10.1001/archinte.163.20.2433
3436:Annals of Emergency Medicine
3244:10.1176/appi.ajp.159.4.672-a
2293:10.3109/15563650.2010.516752
1903:Friedman, Joseph H. (2015).
1699:10.4037/NCI.0000000000000104
1402:
1341:
1104:
959:Food and Drug Administration
919:monoamine oxidase inhibitors
636:Monoamine oxidase inhibitors
7:
5505:Primary progressive aphasia
4892:10.1056/NEJM198803243181209
4411:Frank, Christopher (2008).
3282:10.1056/NEJM200506093522320
2233:10.1056/NEJM200506093522320
1687:AACN Advanced Critical Care
1505:
1112:sensitivity and specificity
483:is a common side effect of
316:monoamine oxidase inhibitor
129:monoamine oxidase inhibitor
10:
7077:
6740:Arthropod bites and stings
6359:Nitrogen dioxide poisoning
5827:Hashimoto's encephalopathy
5533:Posterior cortical atrophy
5354:Striatonigral degeneration
5205:Cavernous sinus thrombosis
4508:10.1177/026988119901300111
4496:J Psychopharmacol (Oxford)
4271:10.5492/wjccm.v13.i2.94707
4230:10.1177/070674370104600718
3012:Clinical Neuropharmacology
2195:10.1016/j.ajem.2008.01.039
1441:postmarketing surveillance
1137:, illicit substances, and
1094:dose-response relationship
744:serotonin releasing agents
582:, sweating, hyperthermia,
301:extensive muscle breakdown
18:
6983:
6955:
6951:
6915:
6859:
6807:
6730:
6646:
6582:
6575:
6534:
6507:
6499:Tricyclic antidepressants
6439:
6421:
6367:
6339:
6309:
6300:
6263:
6245:
6225:
6182:
6134:
6125:
6116:
6098:
5933:Spinal muscular atrophies
5901:Primary lateral sclerosis
5883:
5860:
5844:
5799:
5759:Intracranial hypertension
5749:
5721:
5692:
5658:
5620:
5609:
5575:
5553:
5539:Creutzfeldt–Jakob disease
5478:
5288:
5279:
5265:
5225:
5159:
5068:
4998:
3318:10.1001/archpsyc.60.7.720
3189:Annals of Pharmacotherapy
3112:10.1007/s13181-010-0084-8
3063:10.1007/s13181-010-0021-x
2743:Canadian Family Physician
2604:Annals of Pharmacotherapy
640:tricyclic antidepressants
611:
511:. Mental changes include
320:tricyclic antidepressants
230:
214:
204:
176:
166:
133:tricyclic antidepressants
116:
108:
76:
60:
53:
44:
36:
31:
6000:Progressive bulbar palsy
5791:Intracranial hypotension
5774:Choroid plexus papilloma
5188:Herpesviral encephalitis
4329:10.1177/1178646919873925
3739:"Tramadol Hydrochloride"
3094:Gillman PK (June 2010).
2969:Human Psychopharmacology
2792:10.1517/14740338.7.5.587
1856:"The serotonin syndrome"
1332:monoamine oxidase A
1213:dysfunction and altered
751:substituted amphetamines
395:anticholinergic toxicity
191:anticholinergic toxicity
19:Not to be confused with
6938:List of types of poison
6494:Serotonergic substances
5512:Frontotemporal dementia
5198:Encephalitis lethargica
2651:Minerva Anestesiologica
1548:Ferri, Fred F. (2016).
950:atypical antipsychotics
705:Central nervous system
477:overresponsive reflexes
6226:Other non-toxic metals
5817:Hepatic encephalopathy
3827:10.1212/WNL.10.12.1076
3587:Boyer EW (July 2012).
3476:J Toxicol Clin Toxicol
2698:10.1038/sj.bjp.0707430
1467:
1242:Differential diagnosis
1177:Differential diagnosis
1149:Spontaneous clonus, or
1135:over-the-counter drugs
994:respiratory depression
971:central nervous system
795:alpha-methyltryptamine
456:
391:malignant hyperthermia
380:central nervous system
187:malignant hyperthermia
178:Differential diagnosis
67:Critical care medicine
7051:Clinical pharmacology
6606:Ichthyoallyeinotoxism
5875:Ataxia–telangiectasia
5832:Static encephalopathy
5555:Mitochondrial disease
5393:Spasmodic torticollis
5303:Basal ganglia disease
4846:(February 27, 2007).
4186:Ugeskrift for Lægerer
4022:10.1007/s004060050024
3605:10.1056/NEJMra1202561
3531:10.1081/CLT-120016866
3488:10.1081/CLT-120037428
3403:10.1136/fn.85.2.F145g
2875:Biological Psychiatry
2840:10.1176/ajp.148.6.705
1454:
1433:general practitioners
1310:, norepinephrine, or
1266:serotonin antagonists
1195:neurological disorder
998:loss of consciousness
451:
269:high body temperature
83:High body temperature
5822:Toxic encephalopathy
5528:Lewy bodies dementia
4972:10.1056/NEJMra041867
4759:Medicine (Baltimore)
4583:. Ncbi.nlm.nih.gov.
3902:10.1093/qjmed/hcg062
3782:10.4088/PCC.08l00690
2066:10.1093/qjmed/hcg109
1875:10.1056/NEJMra041867
1610:"Serotonin syndrome"
1127:deep tendon reflexes
1123:Physical examination
975:mechanisms of action
461:increased heart rate
414:serotonin antagonist
356:St. John's wort
263:; usually without a
6976:foodborne illnesses
6933:Lists of poisonings
6616:Shellfish poisoning
6324:Aluminium phosphide
5870:Friedreich's ataxia
5253:Meningoencephalitis
5193:Limbic encephalitis
4490:Gillman PK (1999).
2281:Clinical Toxicology
1614:The Ochsner Journal
1353:muscle contractions
1349:Physical restraints
1334:in the presence of
1139:dietary supplements
1131:mucosa of the mouth
1078:γ-aminobutyric acid
930:5-hydroxytryptophan
872:5-hydroxytryptophan
497:high blood pressure
351:5-hydroxytryptophan
291:. In severe cases,
257:high blood pressure
6928:EPA list of hazard
6710:Alpha-Bungarotoxin
6454:Anticholinesterase
5906:Pseudobulbar palsy
5644:Status epilepticus
5595:Multiple sclerosis
5432:Myoclonic epilepsy
5295:movement disorders
5241:Acute disseminated
5183:Viral encephalitis
5105:Serotonin syndrome
5069:External resources
4952:2021-08-29 at the
4919:The New York Times
3865:Medical Toxicology
2737:serotonin toxicity
2581:10.2146/ajhp060227
1512:Carcinoid syndrome
1476:Bennington College
1468:
1274:activated charcoal
1183:medical conditions
1143:serotonergic agent
1110:which have better
742:(diethylpropion),
668:Dextropropoxyphene
525:metabolic acidosis
493:serotonin agonists
457:
436:Signs and symptoms
426:case of Libby Zion
273:increased reflexes
241:Serotonin syndrome
87:increased reflexes
32:Serotonin syndrome
7046:Neuropharmacology
7031:
7030:
7027:
7026:
6911:
6910:
6893:Poisonous animals
6571:
6570:
6536:Vitamin poisoning
6530:
6529:
6417:
6416:
6296:
6295:
6241:
6240:
6044:
6043:
6040:
6039:
6036:
6035:
5840:
5839:
5745:
5744:
5684:Template:Headache
5650:Template:Epilepsy
5571:
5570:
5545:Vascular dementia
5388:Status dystonicus
5261:
5260:
5236:Encephalomyelitis
5114:
5113:
4417:Can Fam Physician
3874:978-0-7817-2845-4
3699:(20): 2433–2445.
3656:10.1111/bph.14105
3276:(23): 2454–2456.
3201:10.1345/aph.1L260
3195:(11): 1692–1696.
3146:Evans RW (2007).
2881:(11): 1046–1051.
2616:10.1345/aph.1C228
2473:10.1159/000136402
2227:(23): 2454–2456.
1284:controlled trials
1228:Dopamine receptor
1191:anxiety disorders
1050:medulla oblongata
1002:serotergenic drug
943:monoamine oxidase
914:
913:
576:Autonomic effects
551:Cognitive effects
449:
238:
237:
168:Diagnostic method
26:Medical condition
7068:
7015:
7014:
7003:
7002:
6991:
6990:
6964:, which is rare.
6953:
6952:
6888:Venomous animals
6580:
6579:
6437:
6436:
6428:
6427:
6329:Organophosphates
6307:
6306:
6184:Dietary minerals
6132:
6131:
6123:
6122:
6071:
6064:
6057:
6048:
6047:
5858:
5857:
5849:
5848:
5807:Brain herniation
5618:
5617:
5458:Intention tremor
5453:Essential tremor
5318:Postencephalitic
5286:
5285:
5277:
5276:
5166:
5165:
5147:Diseases of the
5141:
5134:
5127:
5118:
5117:
4996:
4995:
4991:
4934:
4933:
4931:
4930:
4910:
4904:
4903:
4875:
4869:
4868:
4866:
4865:
4840:
4834:
4833:
4823:
4799:
4793:
4792:
4774:
4750:
4744:
4743:
4707:
4701:
4700:
4664:
4658:
4657:
4648:(34): 1695–700.
4637:
4631:
4630:
4602:
4596:
4595:
4593:
4592:
4577:
4571:
4570:
4534:
4528:
4527:
4487:
4481:
4480:
4452:
4443:
4442:
4432:
4408:
4402:
4401:
4365:
4359:
4358:
4348:
4308:
4302:
4301:
4291:
4273:
4249:
4243:
4242:
4232:
4217:Can J Psychiatry
4208:
4202:
4201:
4181:
4175:
4174:
4140:
4134:
4133:
4127:
4123:
4121:
4113:
4079:
4073:
4072:
4052:
4046:
4045:
4040:. Archived from
4001:
3995:
3994:
3958:
3949:
3948:
3920:
3914:
3913:
3885:
3879:
3878:
3860:
3847:
3846:
3810:
3804:
3803:
3793:
3761:
3755:
3754:
3752:
3750:
3735:
3729:
3728:
3718:
3708:
3684:
3678:
3677:
3667:
3633:
3627:
3626:
3616:
3584:
3578:
3577:
3549:
3543:
3542:
3514:
3508:
3507:
3471:
3460:
3459:
3431:
3425:
3424:
3414:
3382:
3376:
3375:
3365:
3341:
3330:
3329:
3300:
3294:
3293:
3262:
3256:
3255:
3227:
3221:
3220:
3184:
3178:
3177:
3167:
3143:
3134:
3133:
3123:
3091:
3085:
3084:
3074:
3042:
3036:
3035:
3007:
3001:
3000:
2964:
2958:
2957:
2921:
2915:
2914:
2866:
2860:
2859:
2823:
2812:
2811:
2775:
2769:
2768:
2758:
2726:
2720:
2719:
2709:
2677:
2671:
2670:
2642:
2636:
2635:
2599:
2593:
2592:
2564:
2558:
2557:
2547:
2523:
2514:
2513:
2511:
2510:
2491:
2485:
2484:
2456:
2450:
2449:
2426:
2420:
2419:
2417:
2416:
2410:
2402:
2396:
2395:
2393:
2392:
2377:
2371:
2370:
2368:
2367:
2348:
2342:
2341:
2339:
2338:
2319:
2313:
2312:
2276:
2270:
2269:
2267:
2266:
2251:
2245:
2244:
2216:
2207:
2206:
2178:
2172:
2171:
2169:
2167:
2161:
2154:
2146:
2125:
2124:
2114:
2090:
2079:
2078:
2068:
2044:
2025:
2024:
1980:
1951:
1950:
1930:
1921:
1920:
1900:
1894:
1893:
1891:
1860:
1847:
1728:
1725:
1719:
1718:
1678:
1672:
1671:
1651:
1640:
1639:
1629:
1605:
1566:
1565:
1545:
1393:body temperature
1316:antihypertensive
1289:nasogastric tube
1097:it is a form of
1088:Spectrum concept
1076:antagonists and
1025:neurotransmitter
990:opioid overdoses
932:
926:
877:chlorpheniramine
874:
867:dextromethorphan
846:
728:lisdexamfetamine
619:
618:
584:vasoconstriction
563:mental confusion
450:
353:
347:
336:dextromethorphan
293:body temperature
153:dextromethorphan
49:
29:
28:
7076:
7075:
7071:
7070:
7069:
7067:
7066:
7065:
7036:
7035:
7032:
7023:
6979:
6965:
6947:
6907:
6855:
6803:
6726:
6642:
6567:
6562:
6526:
6503:
6469:Benzodiazepines
6413:
6399:Carbon monoxide
6387:Ethylene glycol
6363:
6335:
6292:
6259:
6237:
6221:
6178:
6112:
6094:
6075:
6045:
6032:
5958:Congenital DSMA
5879:
5836:
5795:
5741:
5729:Sleep disorders
5717:
5694:Cerebrovascular
5688:
5654:
5611:
5605:
5567:
5549:
5474:
5420:Choreoathetosis
5293:
5270:
5257:
5221:
5155:
5145:
5115:
5110:
5109:
5064:
5063:
5007:
4966:(11): 1112–20.
4954:Wayback Machine
4943:
4938:
4937:
4928:
4926:
4911:
4907:
4876:
4872:
4863:
4861:
4841:
4837:
4800:
4796:
4751:
4747:
4708:
4704:
4665:
4661:
4638:
4634:
4607:J Neurosci Nurs
4603:
4599:
4590:
4588:
4579:
4578:
4574:
4535:
4531:
4488:
4484:
4453:
4446:
4409:
4405:
4366:
4362:
4309:
4305:
4250:
4246:
4209:
4205:
4182:
4178:
4163:
4141:
4137:
4125:
4124:
4115:
4114:
4102:
4080:
4076:
4053:
4049:
4002:
3998:
3969:(11): 1046–51.
3963:Biol Psychiatry
3959:
3952:
3921:
3917:
3886:
3882:
3875:
3861:
3850:
3811:
3807:
3762:
3758:
3748:
3746:
3737:
3736:
3732:
3685:
3681:
3634:
3630:
3585:
3581:
3550:
3546:
3515:
3511:
3472:
3463:
3432:
3428:
3383:
3379:
3342:
3333:
3301:
3297:
3263:
3259:
3228:
3224:
3185:
3181:
3144:
3137:
3092:
3088:
3043:
3039:
3008:
3004:
2981:10.1002/hup.750
2965:
2961:
2922:
2918:
2867:
2863:
2824:
2815:
2776:
2772:
2749:(10): 720–727.
2727:
2723:
2678:
2674:
2643:
2639:
2600:
2596:
2565:
2561:
2538:(11): 1439–42.
2524:
2517:
2508:
2506:
2493:
2492:
2488:
2457:
2453:
2427:
2423:
2414:
2412:
2408:
2404:
2403:
2399:
2390:
2388:
2385:DrugWise.org.uk
2379:
2378:
2374:
2365:
2363:
2350:
2349:
2345:
2336:
2334:
2321:
2320:
2316:
2277:
2273:
2264:
2262:
2252:
2248:
2217:
2210:
2189:(7): 840.e3–5.
2179:
2175:
2165:
2163:
2162:on 27 July 2011
2159:
2152:
2148:
2147:
2128:
2091:
2082:
2045:
2028:
1981:
1954:
1931:
1924:
1917:
1901:
1897:
1889:
1869:(11): 1112–20.
1858:
1848:
1731:
1726:
1722:
1679:
1675:
1668:
1652:
1643:
1606:
1569:
1562:
1546:
1525:
1520:
1508:
1449:
1428:
1405:
1373:
1357:lactic acidosis
1344:
1279:benzodiazepines
1262:
1203:sympathomimetic
1199:anticholinergic
1179:
1107:
1090:
1066:pharmacodynamic
1063:
1057:
1048:nuclei and the
1041:
1023:Serotonin is a
1021:
1019:Pathophysiology
1006:antidepressants
928:
922:
870:
844:
773:
759:methylphenidate
724:methamphetamine
631:Antidepressants
614:
440:
438:
410:benzodiazepines
349:
343:
261:fast heart rate
251:medications or
221:Benzodiazepines
27:
24:
17:
12:
11:
5:
7074:
7064:
7063:
7058:
7056:Rare syndromes
7053:
7048:
7029:
7028:
7025:
7024:
7022:
7021:
7009:
6997:
6984:
6981:
6980:
6949:
6948:
6946:
6945:
6940:
6935:
6930:
6925:
6919:
6917:
6913:
6912:
6909:
6908:
6906:
6905:
6903:Mycotoxicology
6900:
6895:
6890:
6885:
6880:
6879:
6878:
6863:
6861:
6860:Related topics
6857:
6856:
6854:
6853:
6848:
6843:
6838:
6833:
6828:
6823:
6817:
6815:
6805:
6804:
6802:
6801:
6799:Tick paralysis
6796:
6795:
6794:
6789:
6775:
6774:
6773:
6766:Scorpion venom
6763:
6762:
6761:
6756:
6742:
6736:
6734:
6728:
6727:
6725:
6724:
6723:
6722:
6717:
6712:
6698:
6693:
6692:
6691:
6681:
6680:
6679:
6674:
6669:
6664:
6653:
6651:
6644:
6643:
6641:
6640:
6639:
6638:
6633:
6628:
6623:
6613:
6608:
6603:
6598:
6592:
6590:
6577:
6573:
6572:
6569:
6568:
6566:
6565:
6560:
6556:
6551:
6546:
6540:
6538:
6532:
6531:
6528:
6527:
6525:
6524:
6519:
6513:
6511:
6509:Cardiovascular
6505:
6504:
6502:
6501:
6496:
6491:
6486:
6481:
6476:
6471:
6466:
6461:
6456:
6451:
6445:
6443:
6434:
6432:Drug overdoses
6425:
6423:Pharmaceutical
6419:
6418:
6415:
6414:
6412:
6411:
6406:
6401:
6396:
6395:
6394:
6389:
6384:
6371:
6369:
6365:
6364:
6362:
6361:
6356:
6351:
6345:
6343:
6337:
6336:
6334:
6333:
6332:
6331:
6326:
6315:
6313:
6304:
6298:
6297:
6294:
6293:
6291:
6290:
6285:
6280:
6275:
6269:
6267:
6261:
6260:
6258:
6257:
6251:
6249:
6243:
6242:
6239:
6238:
6236:
6235:
6229:
6227:
6223:
6222:
6220:
6219:
6214:
6209:
6204:
6199:
6194:
6188:
6186:
6180:
6179:
6177:
6176:
6171:
6166:
6161:
6156:
6151:
6146:
6140:
6138:
6129:
6120:
6114:
6113:
6111:
6110:
6105:
6099:
6096:
6095:
6093:
6092:
6087:
6082:
6074:
6073:
6066:
6059:
6051:
6042:
6041:
6038:
6037:
6034:
6033:
6031:
6030:
6029:
6028:
6017:
6016:
6015:
6014:
6013:
6012:
6007:
5997:
5992:
5991:
5990:
5985:
5980:
5979:
5978:
5973:
5968:
5960:
5955:
5950:
5945:
5940:
5930:
5916:
5915:
5914:
5913:
5908:
5903:
5889:
5887:
5881:
5880:
5878:
5877:
5872:
5866:
5864:
5855:
5846:
5842:
5841:
5838:
5837:
5835:
5834:
5829:
5824:
5819:
5814:
5809:
5803:
5801:
5797:
5796:
5794:
5793:
5788:
5786:Cerebral edema
5783:
5782:
5781:
5776:
5771:
5766:
5755:
5753:
5747:
5746:
5743:
5742:
5740:
5739:
5738:
5737:
5735:Template:Sleep
5725:
5723:
5719:
5718:
5716:
5715:
5709:
5704:
5698:
5696:
5690:
5689:
5687:
5686:
5680:
5675:
5670:
5664:
5662:
5656:
5655:
5653:
5652:
5646:
5641:
5636:
5630:
5628:
5615:
5607:
5606:
5604:
5603:
5597:
5592:
5587:
5581:
5579:
5573:
5572:
5569:
5568:
5566:
5565:
5563:Leigh syndrome
5559:
5557:
5551:
5550:
5548:
5547:
5536:
5535:
5530:
5525:
5524:
5523:
5509:
5508:
5507:
5502:
5501:
5500:
5484:
5482:
5476:
5475:
5473:
5472:
5467:
5462:
5461:
5460:
5455:
5444:
5443:
5442:
5441:
5436:
5435:
5434:
5424:
5423:
5422:
5412:
5407:
5406:
5405:
5400:
5395:
5390:
5374:
5373:
5372:
5371:
5366:
5361:
5356:
5351:
5350:
5349:
5339:
5338:
5337:
5327:
5326:
5325:
5320:
5315:
5299:
5297:
5290:Extrapyramidal
5283:
5274:
5272:encephalopathy
5263:
5262:
5259:
5258:
5256:
5255:
5250:
5245:
5244:
5243:
5232:
5230:
5223:
5222:
5220:
5219:
5218:
5217:
5207:
5202:
5201:
5200:
5195:
5190:
5185:
5174:
5172:
5163:
5157:
5156:
5149:nervous system
5144:
5143:
5136:
5129:
5121:
5112:
5111:
5108:
5107:
5096:
5085:
5073:
5072:
5070:
5066:
5065:
5062:
5061:
5050:
5039:
5024:
5008:
5003:
5002:
5000:
4999:Classification
4993:
4992:
4942:
4941:External links
4939:
4936:
4935:
4905:
4870:
4853:New York Times
4835:
4814:(448): 867–8.
4808:Br J Gen Pract
4794:
4745:
4702:
4659:
4632:
4597:
4572:
4529:
4482:
4444:
4403:
4360:
4303:
4244:
4203:
4176:
4161:
4135:
4126:|journal=
4100:
4074:
4047:
4044:on 1999-10-11.
3996:
3950:
3915:
3880:
3873:
3848:
3821:(12): 1076–8.
3805:
3756:
3730:
3679:
3650:(3): 532–543.
3628:
3599:(2): 146–155.
3579:
3560:(3): 365–368.
3544:
3509:
3461:
3442:(4): 457–459.
3426:
3397:(2): F147–48.
3377:
3356:(448): 871–4.
3350:Br J Gen Pract
3331:
3312:(7): 720–726.
3295:
3257:
3222:
3179:
3135:
3086:
3057:(2): 168–171.
3037:
3018:(5): 219–222.
3002:
2975:(2): 117–125.
2959:
2916:
2861:
2834:(6): 705–713.
2813:
2786:(5): 587–596.
2770:
2721:
2686:Br J Pharmacol
2672:
2657:(1–2): 41–45.
2637:
2610:(3): 388–391.
2594:
2559:
2515:
2486:
2467:(5): 312–316.
2451:
2437:(9): 309–313.
2421:
2397:
2372:
2343:
2314:
2287:(7): 675–694.
2271:
2246:
2208:
2173:
2126:
2080:
2059:(9): 635–642.
2026:
1952:
1941:(4): 296–300.
1922:
1915:
1895:
1854:(March 2005).
1729:
1720:
1693:(4): 285–293.
1673:
1666:
1641:
1567:
1560:
1522:
1521:
1519:
1516:
1515:
1514:
1507:
1504:
1448:
1445:
1427:
1424:
1404:
1401:
1372:
1369:
1365:rhabdomyolysis
1343:
1340:
1318:drugs such as
1304:blood pressure
1270:cyproheptadine
1261:
1258:
1250:extrapyramidal
1224:cyproheptadine
1220:chlorpromazine
1178:
1175:
1174:
1173:
1170:
1160:
1157:
1150:
1106:
1103:
1089:
1086:
1070:norepinephrine
1061:
1055:
1039:
1020:
1017:
912:
911:
909:methylene blue
897:metoclopramide
837:
833:
832:
811:St John's wort
808:
802:
801:
788:
782:
781:
776:
771:
766:
765:
748:hallucinogenic
709:
702:
701:
682:(meperidine),
665:
659:
658:
633:
627:
626:
623:
613:
610:
609:
608:
598:
573:
567:hallucinations
537:kidney failure
529:rhabdomyolysis
513:hypervigilance
469:dilated pupils
437:
434:
430:New York State
422:active cooling
418:cyproheptadine
368:metoclopramide
330:(meperidine),
285:dilated pupils
236:
235:
232:
228:
227:
225:cyproheptadine
218:
212:
211:
209:Active cooling
206:
202:
201:
180:
174:
173:
170:
164:
163:
147:(meperidine),
141:methylene blue
118:
114:
113:
110:
106:
105:
99:dilated pupils
80:
74:
73:
64:
58:
57:
51:
50:
42:
41:
38:
34:
33:
25:
15:
9:
6:
4:
3:
2:
7073:
7062:
7059:
7057:
7054:
7052:
7049:
7047:
7044:
7043:
7041:
7034:
7020:
7019:
7010:
7008:
7007:
6998:
6996:
6995:
6986:
6985:
6982:
6977:
6973:
6969:
6963:
6959:
6954:
6950:
6944:
6941:
6939:
6936:
6934:
6931:
6929:
6926:
6924:
6921:
6920:
6918:
6916:Miscellaneous
6914:
6904:
6901:
6899:
6898:Deadly fungus
6896:
6894:
6891:
6889:
6886:
6884:
6881:
6877:
6874:
6873:
6872:
6868:
6865:
6864:
6862:
6858:
6852:
6849:
6847:
6844:
6842:
6839:
6837:
6834:
6832:
6829:
6827:
6824:
6822:
6819:
6818:
6816:
6814:
6810:
6806:
6800:
6797:
6793:
6790:
6788:
6784:
6781:
6780:
6779:
6776:
6772:
6771:Charybdotoxin
6769:
6768:
6767:
6764:
6760:
6757:
6755:
6752:
6751:
6750:
6746:
6743:
6741:
6738:
6737:
6735:
6733:
6729:
6721:
6718:
6716:
6713:
6711:
6708:
6707:
6706:
6702:
6699:
6697:
6694:
6690:
6687:
6686:
6685:
6682:
6678:
6675:
6673:
6670:
6668:
6665:
6663:
6662:Batrachotoxin
6660:
6659:
6658:
6655:
6654:
6652:
6650:
6645:
6637:
6634:
6632:
6629:
6627:
6624:
6622:
6619:
6618:
6617:
6614:
6612:
6609:
6607:
6604:
6602:
6599:
6597:
6594:
6593:
6591:
6589:
6585:
6581:
6578:
6574:
6564:
6559:Megavitamin-B
6557:
6555:
6552:
6550:
6547:
6545:
6542:
6541:
6539:
6537:
6533:
6523:
6520:
6518:
6515:
6514:
6512:
6510:
6506:
6500:
6497:
6495:
6492:
6490:
6487:
6485:
6482:
6480:
6477:
6475:
6472:
6470:
6467:
6465:
6462:
6460:
6457:
6455:
6452:
6450:
6447:
6446:
6444:
6442:
6438:
6435:
6433:
6429:
6426:
6424:
6420:
6410:
6407:
6405:
6402:
6400:
6397:
6393:
6390:
6388:
6385:
6383:
6380:
6379:
6378:
6377:
6373:
6372:
6370:
6366:
6360:
6357:
6355:
6352:
6350:
6347:
6346:
6344:
6342:
6338:
6330:
6327:
6325:
6322:
6321:
6320:
6317:
6316:
6314:
6312:
6308:
6305:
6303:
6299:
6289:
6286:
6284:
6281:
6279:
6276:
6274:
6273:Sulfuric acid
6271:
6270:
6268:
6266:
6262:
6256:
6253:
6252:
6250:
6248:
6244:
6234:
6231:
6230:
6228:
6224:
6218:
6215:
6213:
6210:
6208:
6205:
6203:
6200:
6198:
6195:
6193:
6190:
6189:
6187:
6185:
6181:
6175:
6172:
6170:
6167:
6165:
6162:
6160:
6157:
6155:
6152:
6150:
6147:
6145:
6142:
6141:
6139:
6137:
6133:
6130:
6128:
6124:
6121:
6119:
6115:
6109:
6106:
6104:
6101:
6100:
6097:
6091:
6088:
6086:
6083:
6081:
6078:
6077:
6072:
6067:
6065:
6060:
6058:
6053:
6052:
6049:
6027:
6024:
6023:
6022:
6019:
6018:
6011:
6008:
6006:
6003:
6002:
6001:
5998:
5996:
5993:
5989:
5986:
5984:
5981:
5977:
5974:
5972:
5969:
5967:
5964:
5963:
5961:
5959:
5956:
5954:
5951:
5949:
5946:
5944:
5941:
5939:
5936:
5935:
5934:
5931:
5929:
5926:
5925:
5924:
5922:
5918:
5917:
5912:
5909:
5907:
5904:
5902:
5899:
5898:
5897:
5895:
5891:
5890:
5888:
5886:
5882:
5876:
5873:
5871:
5868:
5867:
5865:
5863:
5859:
5856:
5854:
5850:
5847:
5843:
5833:
5830:
5828:
5825:
5823:
5820:
5818:
5815:
5813:
5812:Reye syndrome
5810:
5808:
5805:
5804:
5802:
5798:
5792:
5789:
5787:
5784:
5780:
5777:
5775:
5772:
5770:
5767:
5765:
5764:Hydrocephalus
5762:
5761:
5760:
5757:
5756:
5754:
5752:
5748:
5736:
5732:
5731:
5730:
5727:
5726:
5724:
5720:
5714:
5710:
5708:
5705:
5703:
5700:
5699:
5697:
5695:
5691:
5685:
5681:
5679:
5676:
5674:
5671:
5669:
5666:
5665:
5663:
5661:
5657:
5651:
5647:
5645:
5642:
5640:
5637:
5635:
5632:
5631:
5629:
5627:
5623:
5619:
5616:
5614:
5608:
5602:
5598:
5596:
5593:
5591:
5588:
5586:
5583:
5582:
5580:
5578:
5577:Demyelinating
5574:
5564:
5561:
5560:
5558:
5556:
5552:
5546:
5543:
5542:
5541:
5540:
5534:
5531:
5529:
5526:
5522:
5519:
5518:
5517:
5513:
5510:
5506:
5503:
5499:
5496:
5495:
5494:
5491:
5490:
5489:
5486:
5485:
5483:
5481:
5477:
5471:
5468:
5466:
5465:Restless legs
5463:
5459:
5456:
5454:
5451:
5450:
5449:
5446:
5445:
5440:
5437:
5433:
5430:
5429:
5428:
5425:
5421:
5418:
5417:
5416:
5413:
5411:
5408:
5404:
5403:Blepharospasm
5401:
5399:
5396:
5394:
5391:
5389:
5386:
5385:
5384:
5381:
5380:
5379:
5376:
5375:
5370:
5367:
5365:
5362:
5360:
5359:Hemiballismus
5357:
5355:
5352:
5348:
5345:
5344:
5343:
5340:
5336:
5333:
5332:
5331:
5328:
5324:
5321:
5319:
5316:
5314:
5311:
5310:
5309:
5306:
5305:
5304:
5301:
5300:
5298:
5296:
5291:
5287:
5284:
5282:
5278:
5275:
5273:
5268:
5264:
5254:
5251:
5249:
5246:
5242:
5239:
5238:
5237:
5234:
5233:
5231:
5229:
5224:
5216:
5213:
5212:
5211:
5210:Brain abscess
5208:
5206:
5203:
5199:
5196:
5194:
5191:
5189:
5186:
5184:
5181:
5180:
5179:
5176:
5175:
5173:
5171:
5167:
5164:
5162:
5158:
5154:
5150:
5142:
5137:
5135:
5130:
5128:
5123:
5122:
5119:
5106:
5102:
5101:
5097:
5095:
5091:
5090:
5086:
5084:
5080:
5079:
5075:
5074:
5071:
5067:
5060:
5056:
5055:
5051:
5049:
5045:
5044:
5040:
5038:
5034:
5033:
5029:
5025:
5023:
5019:
5018:
5014:
5010:
5009:
5006:
5001:
4997:
4989:
4985:
4981:
4977:
4973:
4969:
4965:
4961:
4955:
4951:
4948:
4945:
4944:
4924:
4920:
4916:
4909:
4901:
4897:
4893:
4889:
4886:(12): 771–5.
4885:
4881:
4874:
4859:
4855:
4854:
4849:
4845:
4839:
4831:
4827:
4822:
4817:
4813:
4809:
4805:
4798:
4790:
4786:
4782:
4778:
4773:
4768:
4764:
4760:
4756:
4749:
4741:
4737:
4733:
4729:
4725:
4721:
4718:(3): 183–97.
4717:
4713:
4706:
4698:
4694:
4690:
4686:
4682:
4678:
4674:
4670:
4669:Crit Care Med
4663:
4655:
4651:
4647:
4643:
4636:
4628:
4624:
4620:
4616:
4612:
4608:
4601:
4586:
4582:
4576:
4568:
4564:
4560:
4556:
4552:
4548:
4544:
4540:
4533:
4525:
4521:
4517:
4513:
4509:
4505:
4501:
4497:
4493:
4486:
4478:
4474:
4470:
4466:
4462:
4458:
4451:
4449:
4440:
4436:
4431:
4426:
4423:(7): 988–92.
4422:
4418:
4414:
4407:
4399:
4395:
4391:
4387:
4383:
4379:
4376:(2): 94–104.
4375:
4371:
4364:
4356:
4352:
4347:
4342:
4338:
4334:
4330:
4326:
4322:
4318:
4314:
4307:
4299:
4295:
4290:
4285:
4281:
4277:
4272:
4267:
4263:
4259:
4255:
4248:
4240:
4236:
4231:
4226:
4222:
4218:
4214:
4207:
4199:
4195:
4191:
4187:
4180:
4172:
4168:
4164:
4162:9780444640741
4158:
4154:
4150:
4146:
4139:
4131:
4119:
4111:
4107:
4103:
4101:9780444519269
4097:
4093:
4089:
4085:
4078:
4070:
4066:
4062:
4058:
4051:
4043:
4039:
4035:
4031:
4027:
4023:
4019:
4016:(2): 96–103.
4015:
4011:
4007:
4000:
3992:
3988:
3984:
3980:
3976:
3972:
3968:
3964:
3957:
3955:
3946:
3942:
3938:
3934:
3930:
3926:
3919:
3911:
3907:
3903:
3899:
3896:(5): 369–74.
3895:
3891:
3884:
3876:
3870:
3866:
3859:
3857:
3855:
3853:
3844:
3840:
3836:
3832:
3828:
3824:
3820:
3816:
3809:
3801:
3797:
3792:
3787:
3783:
3779:
3775:
3771:
3767:
3760:
3744:
3740:
3734:
3726:
3722:
3717:
3712:
3707:
3702:
3698:
3694:
3690:
3683:
3675:
3671:
3666:
3661:
3657:
3653:
3649:
3645:
3644:
3639:
3632:
3624:
3620:
3615:
3610:
3606:
3602:
3598:
3594:
3590:
3583:
3575:
3571:
3567:
3563:
3559:
3555:
3548:
3540:
3536:
3532:
3528:
3525:(5): 668–69.
3524:
3520:
3513:
3505:
3501:
3497:
3493:
3489:
3485:
3482:(3): 277–85.
3481:
3477:
3470:
3468:
3466:
3457:
3453:
3449:
3445:
3441:
3437:
3430:
3422:
3418:
3413:
3408:
3404:
3400:
3396:
3392:
3388:
3381:
3373:
3369:
3364:
3359:
3355:
3351:
3347:
3340:
3338:
3336:
3327:
3323:
3319:
3315:
3311:
3307:
3299:
3291:
3287:
3283:
3279:
3275:
3271:
3270:
3261:
3253:
3249:
3245:
3241:
3238:(4): 672–73.
3237:
3233:
3226:
3218:
3214:
3210:
3206:
3202:
3198:
3194:
3190:
3183:
3175:
3171:
3166:
3161:
3157:
3153:
3149:
3142:
3140:
3131:
3127:
3122:
3117:
3113:
3109:
3106:(2): 276–77.
3105:
3101:
3097:
3090:
3082:
3078:
3073:
3068:
3064:
3060:
3056:
3052:
3048:
3041:
3033:
3029:
3025:
3021:
3017:
3013:
3006:
2998:
2994:
2990:
2986:
2982:
2978:
2974:
2970:
2963:
2955:
2951:
2947:
2943:
2939:
2935:
2932:(2): 241–42.
2931:
2927:
2920:
2912:
2908:
2904:
2900:
2896:
2892:
2888:
2884:
2880:
2876:
2872:
2865:
2857:
2853:
2849:
2845:
2841:
2837:
2833:
2829:
2822:
2820:
2818:
2809:
2805:
2801:
2797:
2793:
2789:
2785:
2781:
2774:
2766:
2762:
2757:
2752:
2748:
2744:
2740:
2738:
2732:
2725:
2717:
2713:
2708:
2703:
2699:
2695:
2692:(6): 946–51.
2691:
2687:
2683:
2676:
2668:
2664:
2660:
2656:
2652:
2648:
2641:
2633:
2629:
2625:
2621:
2617:
2613:
2609:
2605:
2598:
2590:
2586:
2582:
2578:
2574:
2570:
2563:
2555:
2551:
2546:
2541:
2537:
2533:
2529:
2522:
2520:
2504:
2500:
2496:
2490:
2482:
2478:
2474:
2470:
2466:
2462:
2455:
2448:
2444:
2440:
2436:
2432:
2425:
2407:
2401:
2386:
2382:
2376:
2361:
2357:
2353:
2347:
2332:
2328:
2324:
2318:
2310:
2306:
2302:
2298:
2294:
2290:
2286:
2282:
2275:
2261:
2260:HealthCentral
2257:
2250:
2242:
2238:
2234:
2230:
2226:
2222:
2215:
2213:
2204:
2200:
2196:
2192:
2188:
2184:
2177:
2158:
2151:
2145:
2143:
2141:
2139:
2137:
2135:
2133:
2131:
2122:
2118:
2113:
2108:
2104:
2100:
2099:Pain Medicine
2096:
2089:
2087:
2085:
2076:
2072:
2067:
2062:
2058:
2054:
2050:
2043:
2041:
2039:
2037:
2035:
2033:
2031:
2022:
2018:
2014:
2010:
2006:
2002:
1998:
1994:
1990:
1986:
1979:
1977:
1975:
1973:
1971:
1969:
1967:
1965:
1963:
1961:
1959:
1957:
1948:
1944:
1940:
1936:
1929:
1927:
1918:
1916:9781107066007
1912:
1908:
1907:
1899:
1888:
1884:
1880:
1876:
1872:
1868:
1864:
1857:
1853:
1846:
1844:
1842:
1840:
1838:
1836:
1834:
1832:
1830:
1828:
1826:
1824:
1822:
1820:
1818:
1816:
1814:
1812:
1810:
1808:
1806:
1804:
1802:
1800:
1798:
1796:
1794:
1792:
1790:
1788:
1786:
1784:
1782:
1780:
1778:
1776:
1774:
1772:
1770:
1768:
1766:
1764:
1762:
1760:
1758:
1756:
1754:
1752:
1750:
1748:
1746:
1744:
1742:
1740:
1738:
1736:
1734:
1724:
1716:
1712:
1708:
1704:
1700:
1696:
1692:
1688:
1684:
1677:
1669:
1667:9781451188509
1663:
1659:
1658:
1650:
1648:
1646:
1637:
1633:
1628:
1623:
1620:(4): 533–40.
1619:
1615:
1611:
1604:
1602:
1600:
1598:
1596:
1594:
1592:
1590:
1588:
1586:
1584:
1582:
1580:
1578:
1576:
1574:
1572:
1563:
1561:9780323448383
1557:
1553:
1552:
1544:
1542:
1540:
1538:
1536:
1534:
1532:
1530:
1528:
1523:
1513:
1510:
1509:
1503:
1501:
1497:
1493:
1489:
1485:
1481:
1477:
1473:
1465:
1461:
1457:
1453:
1447:Notable cases
1444:
1442:
1438:
1434:
1423:
1421:
1416:
1414:
1410:
1400:
1398:
1394:
1390:
1386:
1385:Suxamethonium
1382:
1378:
1368:
1366:
1362:
1358:
1354:
1350:
1339:
1337:
1333:
1329:
1325:
1321:
1320:nitroprusside
1317:
1313:
1312:phenylephrine
1309:
1305:
1301:
1297:
1292:
1290:
1285:
1280:
1275:
1271:
1267:
1257:
1255:
1251:
1247:
1243:
1239:
1237:
1236:bromocriptine
1233:
1229:
1225:
1221:
1216:
1215:mental status
1212:
1208:
1204:
1200:
1196:
1192:
1188:
1187:viral illness
1184:
1171:
1168:
1167:hyperreflexia
1164:
1161:
1158:
1155:
1151:
1148:
1147:
1146:
1144:
1140:
1136:
1132:
1128:
1124:
1120:
1115:
1113:
1102:
1100:
1095:
1085:
1083:
1079:
1075:
1074:NMDA receptor
1071:
1067:
1059:
1051:
1047:
1043:
1035:
1031:
1026:
1016:
1014:
1009:
1007:
1003:
999:
995:
991:
986:
984:
980:
976:
972:
968:
962:
960:
955:
951:
946:
944:
940:
939:cheese effect
936:
931:
925:
920:
910:
906:
902:
898:
894:
890:
886:
882:
878:
873:
868:
864:
860:
856:
852:
848:
841:
838:
835:
834:
831:
827:
823:
821:
816:
812:
809:
807:
804:
803:
800:
796:
792:
789:
787:
784:
783:
780:
777:
774:
768:
767:
764:
760:
756:
752:
749:
745:
741:
737:
733:
729:
725:
721:
717:
713:
710:
708:
704:
703:
700:
696:
693:
692:buprenorphine
689:
685:
681:
677:
673:
669:
666:
664:
661:
660:
657:
653:
649:
645:
641:
637:
634:
632:
629:
628:
624:
621:
620:
617:
606:
605:hyperreflexia
602:
599:
597:
593:
589:
585:
581:
577:
574:
572:
568:
564:
560:
557:, agitation,
556:
552:
549:
548:
547:
544:
542:
538:
534:
530:
526:
522:
518:
514:
510:
506:
502:
498:
494:
490:
487:'s action on
486:
482:
478:
474:
470:
466:
463:, shivering,
462:
454:
433:
431:
427:
423:
419:
415:
411:
406:
404:
400:
396:
392:
388:
383:
381:
377:
373:
369:
365:
361:
357:
352:
346:
341:
337:
333:
329:
325:
321:
317:
313:
309:
304:
302:
298:
294:
290:
286:
282:
278:
274:
271:, agitation,
270:
266:
262:
258:
254:
250:
246:
242:
233:
229:
226:
222:
219:
217:
213:
210:
207:
203:
200:
196:
192:
188:
184:
181:
179:
175:
171:
169:
165:
162:
158:
154:
150:
146:
142:
138:
134:
130:
126:
122:
119:
115:
111:
107:
104:
100:
96:
92:
88:
85:, agitation,
84:
81:
79:
75:
72:
68:
65:
63:
59:
56:
52:
48:
43:
39:
35:
30:
22:
7033:
7016:
7004:
6992:
6787:Latrodectism
6778:spider venom
6601:Haff disease
6522:Dipyridamole
6493:
6464:Barbiturates
6374:
6136:Toxic metals
6020:
5919:
5892:
5853:Degenerative
5590:Inflammatory
5537:
5470:Stiff-person
5308:Parkinsonism
5281:Degenerative
5178:Encephalitis
5161:Inflammation
5151:, primarily
5098:
5087:
5076:
5052:
5041:
5026:
5011:
4963:
4960:N Engl J Med
4959:
4927:. Retrieved
4918:
4908:
4883:
4880:N Engl J Med
4879:
4873:
4862:. Retrieved
4851:
4838:
4811:
4807:
4797:
4765:(4): 201–9.
4762:
4758:
4748:
4715:
4711:
4705:
4675:(2): 473–6.
4672:
4668:
4662:
4645:
4641:
4635:
4613:(2): 102–5.
4610:
4606:
4600:
4589:. Retrieved
4575:
4545:(1): 23–31.
4542:
4538:
4532:
4502:(1): 100–9.
4499:
4495:
4485:
4463:(4): 615–9.
4460:
4456:
4420:
4416:
4406:
4373:
4369:
4363:
4320:
4316:
4306:
4264:(2): 94707.
4261:
4257:
4247:
4223:(7): 657–9.
4220:
4216:
4206:
4192:(3): 301–2.
4189:
4185:
4179:
4144:
4138:
4083:
4077:
4063:(5): 143–4.
4060:
4056:
4050:
4042:the original
4013:
4009:
3999:
3966:
3962:
3931:(2): 231–2.
3928:
3924:
3918:
3893:
3889:
3883:
3864:
3818:
3814:
3808:
3773:
3769:
3759:
3747:. Retrieved
3742:
3733:
3696:
3692:
3682:
3647:
3641:
3631:
3596:
3592:
3582:
3557:
3553:
3547:
3522:
3518:
3512:
3479:
3475:
3439:
3435:
3429:
3394:
3390:
3380:
3353:
3349:
3309:
3305:
3298:
3273:
3267:
3260:
3235:
3231:
3225:
3192:
3188:
3182:
3155:
3151:
3103:
3099:
3089:
3054:
3050:
3040:
3015:
3011:
3005:
2972:
2968:
2962:
2929:
2925:
2919:
2878:
2874:
2864:
2831:
2827:
2783:
2779:
2773:
2746:
2742:
2736:
2724:
2689:
2685:
2675:
2654:
2650:
2640:
2607:
2603:
2597:
2575:(1): 59–62.
2572:
2568:
2562:
2535:
2531:
2507:. Retrieved
2498:
2489:
2464:
2461:Pharmacology
2460:
2454:
2446:
2434:
2430:
2424:
2413:. Retrieved
2400:
2389:. Retrieved
2387:. 2016-01-03
2384:
2375:
2364:. Retrieved
2355:
2346:
2335:. Retrieved
2326:
2317:
2284:
2280:
2274:
2263:. Retrieved
2259:
2249:
2224:
2220:
2186:
2182:
2176:
2164:. Retrieved
2157:the original
2105:(1): 63–74.
2102:
2098:
2056:
2052:
1995:(6): 361–5.
1992:
1988:
1938:
1934:
1905:
1898:
1866:
1862:
1723:
1690:
1686:
1676:
1656:
1617:
1613:
1550:
1469:
1429:
1426:Epidemiology
1417:
1406:
1397:hypothalamic
1374:
1371:Hyperthermia
1345:
1293:
1263:
1254:hyperkinesia
1246:Bradykinesia
1240:
1180:
1116:
1108:
1091:
1046:central grey
1022:
1010:
987:
963:
947:
924:L-tryptophan
915:
819:
786:Psychedelics
615:
545:
501:hyperthermia
458:
407:
384:
345:L-tryptophan
324:amphetamines
305:
249:serotonergic
244:
240:
239:
112:Within a day
7018:WikiProject
6831:Fish toxins
6792:Loxoscelism
6705:Snake venom
6677:Physalaemin
6649:vertebrates
6489:Paracetamol
6005:Fazio–Londe
5845:Both/either
5639:Generalised
5498:Early-onset
5493:Alzheimer's
5228:spinal cord
5078:MedlinePlus
4844:Brody, Jane
4457:J Emerg Med
3749:12 December
2731:Grindrod KA
1484:disoriented
1389:Antipyretic
1328:propranolol
1308:epinephrine
1232:neuroleptic
1201:poisoning,
1154:diaphoresis
983:amphetamine
954:mirtazapine
893:granisetron
889:ondansetron
881:risperidone
755:sibutramine
740:amfepramone
736:phentermine
732:amphetamine
699:hydrocodone
688:pentazocine
588:tachycardia
509:upper limbs
399:heat stroke
195:heat stroke
157:ondansetron
137:amphetamine
109:Usual onset
37:Other names
7040:Categories
6966:including
6923:Antibiotic
6851:Strychnine
6821:Cinchonism
6783:Latrotoxin
6732:Arthropods
6720:Batroxobin
6631:Neurotoxic
6626:Diarrhetic
6576:Biological
6319:Pesticides
6311:Phosphorus
6247:Metalloids
5613:paroxysmal
5585:Autoimmune
5378:Dyskinesia
5248:Meningitis
5226:Brain and
5100:Patient UK
5054:DiseasesDB
4929:2008-12-08
4864:2009-02-13
4642:Presse Med
4591:2013-01-28
3776:(5): 273.
2729:Foong AL,
2509:2013-01-28
2499:Erowid.org
2415:2019-11-18
2391:2019-11-18
2366:2017-03-22
2337:2017-03-22
2327:RxList.com
2265:2024-06-30
1989:Med J Aust
1850:Boyer EW,
1518:References
1496:phenelzine
1472:Libby Zion
1464:Libby Zion
1456:Phenelzine
1437:nefazodone
1381:intubation
1377:vecuronium
1296:olanzapine
1260:Management
1030:tryptophan
905:metaxalone
885:olanzapine
840:Tryptophan
815:Syrian rue
707:stimulants
676:tapentadol
652:nefazodone
403:meningitis
216:Medication
199:meningitis
71:psychiatry
6943:Pollution
6883:Cnidocyte
6836:Lathyrism
6749:Bee venom
6745:Bee sting
6689:Coturnism
6672:Bufotenin
6657:Amphibian
6636:Paralytic
6611:Scombroid
6596:Ciguatera
6554:Vitamin E
6549:Vitamin D
6544:Vitamin A
6265:Nonmetals
6212:Manganese
6144:Beryllium
6118:Inorganic
6080:Poisoning
5610:Episodic/
5488:Tauopathy
5439:Akathisia
5427:Myoclonus
5410:Athetosis
5342:Tauopathy
5089:eMedicine
4539:Brain Res
4337:1178-6469
4280:2220-3141
4128:ignored (
4118:cite book
3815:Neurology
3743:drugs.com
3554:Addiction
3539:218865517
3158:(3): 48.
3152:MedGenMed
2895:0006-3223
1852:Shannon M
1707:1559-7768
1492:pethidine
1488:hydration
1413:half-life
1403:Prognosis
1342:Agitation
1300:asenapine
1211:autonomic
1119:akathisia
1105:Diagnosis
1099:poisoning
1082:overdoses
1058:receptors
1042:receptors
935:ayahuasca
901:ritonavir
863:linezolid
855:buspirone
851:valproate
775:agonists
695:oxycodone
680:pethidine
656:trazodone
638:(MAOIs),
580:shivering
559:hypomania
521:agitation
473:myoclonus
376:serotonin
340:buspirone
328:pethidine
231:Frequency
205:Treatment
145:pethidine
62:Specialty
55:Serotonin
6994:Category
6846:Mushroom
6826:Ergotism
6811: /
6785: /
6759:Melittin
6747: /
6703: /
6667:Bombesin
6586: /
6563:syndrome
6392:Methanol
6354:Nicotine
6341:Nitrogen
6288:Fluoride
6283:Chlorine
6278:Selenium
6192:Chromium
6169:Thallium
6090:Overdose
6085:Toxicity
5976:SMALED2B
5971:SMALED2A
5668:Migraine
5660:Headache
5626:epilepsy
5622:Seizures
5480:Dementia
5383:Dystonia
5094:ped/2786
4988:37959124
4980:15784664
4950:Archived
4923:Archived
4858:Archived
4830:10818648
4789:41036864
4781:10941349
4740:26897797
4732:11347722
4712:Drug Saf
4697:28908329
4689:11889332
4654:11760601
4627:16681290
4585:Archived
4567:29995925
4559:11164765
4524:17640246
4516:10221364
4439:18625822
4398:19809259
4370:Drug Saf
4355:31523132
4298:38855279
4289:11155509
4239:11582830
4198:11219110
4171:30459031
4110:17645916
4069:16010782
4057:Ir Med J
4038:37993326
3991:12179122
3983:16460699
3945:15209988
3925:Pain Med
3910:12702786
3843:40439836
3835:13730138
3800:19956471
3725:14609780
3674:29210063
3623:22784117
3574:12603236
3504:43121327
3496:15362595
3456:10092727
3421:11561552
3372:10818650
3326:12860776
3290:15948272
3252:11925312
3217:24942783
3209:18957623
3174:18092054
3130:20440594
3081:20238197
3032:15602102
2997:23442056
2989:16342227
2946:12667176
2911:12179122
2903:16460699
2856:29916415
2808:71657093
2800:18759711
2765:30315014
2716:17721552
2667:Archived
2663:18004234
2632:36677580
2624:12639169
2589:17189581
2554:12771076
2503:Archived
2443:15635814
2360:Archived
2331:Archived
2309:42588722
2301:20849327
2241:15948273
2203:18774063
2121:12873279
2075:12925718
2021:Archived
2017:13108173
2009:17874986
1887:Archived
1883:15784664
1715:26484986
1636:24358002
1506:See also
1409:delirium
1361:sedation
1268:such as
1004:such as
979:tramadol
967:in utero
779:Triptans
720:caffeine
684:fentanyl
672:tramadol
642:(TCAs),
596:diarrhea
555:headache
533:seizures
517:insomnia
489:dopamine
465:sweating
416:such as
360:triptans
332:tramadol
322:(TCAs),
318:(MAOI),
314:(SNRI),
310:(SSRI),
297:seizures
289:diarrhea
281:sweating
149:tramadol
135:(TCAs),
131:(MAOI),
127:(SNRI),
123:(SSRI),
103:diarrhea
95:sweating
78:Symptoms
7006:Commons
6962:argyria
6871:Stinger
6841:Locoism
6621:Amnesic
6588:Seafood
6517:Digoxin
6484:Opioids
6479:Lithium
6474:Cocaine
6459:Aspirin
6449:Alcohol
6441:Nervous
6409:Toluene
6382:Ethanol
6376:alcohol
6349:Cyanide
6302:Organic
6255:Arsenic
6159:Mercury
6149:Cadmium
6108:History
5988:SMA-PME
5983:SMA-PCH
5966:SMALED1
5678:Tension
5673:Cluster
5398:Meige's
5215:Amoebic
5048:D020230
4900:3347226
4821:1313553
4477:9696181
4430:2464814
4390:7576268
4346:6734608
4030:9684919
3791:2781045
3716:3739053
3665:5773950
3614:3739053
3412:1721292
3363:1313555
3165:2100123
3121:3550296
3072:3550303
2848:2035713
2756:6184959
2707:2078225
2481:4737998
2166:16 July
1947:9757752
1627:3865832
1324:esmolol
1034:agonism
859:lithium
836:Others
830:yohimbe
822:ginseng
763:cocaine
663:Opioids
601:Somatic
378:on the
372:cocaine
234:Unknown
161:cocaine
6972:toxins
6968:venoms
6958:Silver
6809:Plants
6754:Apamin
6715:Ancrod
6701:Snakes
6696:Mammal
6647:Other
6404:Oxygen
6233:Silver
6202:Copper
6197:Cobalt
6164:Nickel
6127:Metals
6103:Poison
5707:Stroke
5521:Pick's
5448:Tremor
5415:Chorea
5083:007272
5037:333.99
4986:
4978:
4898:
4828:
4818:
4787:
4779:
4738:
4730:
4695:
4687:
4652:
4625:
4565:
4557:
4522:
4514:
4475:
4437:
4427:
4396:
4388:
4353:
4343:
4335:
4296:
4286:
4278:
4237:
4196:
4169:
4159:
4108:
4098:
4067:
4036:
4028:
3989:
3981:
3943:
3908:
3871:
3841:
3833:
3798:
3788:
3723:
3713:
3672:
3662:
3621:
3611:
3572:
3537:
3502:
3494:
3454:
3419:
3409:
3370:
3360:
3324:
3288:
3250:
3215:
3207:
3172:
3162:
3128:
3118:
3079:
3069:
3030:
2995:
2987:
2954:851495
2952:
2944:
2909:
2901:
2893:
2854:
2846:
2806:
2798:
2763:
2753:
2714:
2704:
2661:
2630:
2622:
2587:
2552:
2545:155963
2542:
2479:
2441:
2356:RxList
2307:
2299:
2239:
2201:
2119:
2073:
2015:
2007:
1945:
1913:
1881:
1713:
1705:
1664:
1634:
1624:
1558:
1336:oxygen
1163:Tremor
826:nutmeg
622:Class
612:Causes
592:nausea
539:, and
505:clonus
481:Tremor
453:Clonus
401:, and
287:, and
277:tremor
259:and a
117:Causes
91:tremor
6876:plant
6813:Fungi
6684:Birds
6021:both:
5953:DSMA1
5948:SMAX2
5943:SMAX1
5923:only:
5896:only:
5800:Other
5722:Other
5634:Focal
5267:Brain
5170:Brain
5059:30044
4984:S2CID
4956:from
4785:S2CID
4736:S2CID
4693:S2CID
4563:S2CID
4520:S2CID
4394:S2CID
4034:S2CID
3987:S2CID
3839:S2CID
3535:S2CID
3500:S2CID
3213:S2CID
2993:S2CID
2950:S2CID
2907:S2CID
2852:S2CID
2804:S2CID
2628:S2CID
2409:(PDF)
2381:"AMT"
2305:S2CID
2160:(PDF)
2153:(PDF)
2013:S2CID
1890:(PDF)
1859:(PDF)
1458:is a
1165:plus
847:-DOPA
820:Panax
806:Herbs
746:like
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