{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T20:38:44Z","timestamp":1767904724540,"version":"3.49.0"},"reference-count":21,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2015,4,22]],"date-time":"2015-04-22T00:00:00Z","timestamp":1429660800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["accpjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pharmacotherapy"],"published-print":{"date-parts":[[2015,6]]},"abstract":"<jats:p>Serotonin syndrome is a potentially life\u2010threatening condition caused by excessive central and peripheral stimulation of serotonin brainstem receptors, usually triggered by inadvertent interactions between agents with serotonergic activity. Evidence supporting an association between nonserotonergic opiates, such as oxycodone or morphine, and serotonin syndrome is very limited and even contradictory. In this case report, we describe a patient who developed serotonergic\u2010adverse effects likely precipitated by an interaction between morphine and phenelzine. A 57\u2010year\u2010old woman presented to the emergency department with complaints of increasing visual hallucinations, restlessness, photophobia, dizziness, neck stiffness, occipital headache, confusion, sweating, tachycardia, and nausea over the previous week. On admission, her blood pressure was 185\/65\u00a0mm Hg, and clonus was noted in the lower extremities. The patient was hospitalized 10\u00a0days earlier for cellulitis of the left breast secondary to a left mastectomy 5\u00a0months earlier, and a short course of oral morphine was prescribed for pain control. Her routine medications consisted of aspirin, atorvastatin, bisoprolol, clopidogrel, gabapentin, omeprazole, phenelzine, and ramipril. Supportive measures were initiated on admission. Phenelzine and morphine were discontinued immediately, leading to a progressive resolution of symptoms over the next 48\u00a0hours. Phenelzine was restarted on discharge without further complications. Use of the Drug Interaction Probability Scale indicated a probable relationship (score of 6) between the patient's development of serotonin syndrome and the combination of morphine and phenelzine. The mechanism underlying this interaction, however, remains unclear and warrants further investigation. Clinicians should carefully weigh the risk and benefits of initiating morphine in patients taking monoamine oxidase inhibitors or any other serotonin\u2010enhancing drugs.<\/jats:p>","DOI":"10.1002\/phar.1581","type":"journal-article","created":{"date-parts":[[2015,4,22]],"date-time":"2015-04-22T03:03:04Z","timestamp":1429671784000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Serotonin Syndrome Probably Triggered by a Morphine\u2013Phenelzine Interaction"],"prefix":"10.1002","volume":"35","author":[{"given":"Hector","family":"Mateo\u2010Carrasco","sequence":"first","affiliation":[{"name":"Cancer Services Pharmacy Department Northampton General Hospital NHS Trust Northampton UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eva Mar\u00eda","family":"Mu\u00f1oz\u2010Aguilera","sequence":"additional","affiliation":[{"name":"Oral and Maxillofacial Surgery Maxillofacial Unit and Orthodontics Northampton General Hospital NHS Trust Northampton UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juan Manuel","family":"Garc\u00eda\u2010Torrecillas","sequence":"additional","affiliation":[{"name":"Emergency Department Torrec\u00e1rdenas Hospital Almer\u00eda Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiba","family":"Abu Al\u2010Robb","sequence":"additional","affiliation":[{"name":"UCLH London London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2015,4,22]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/NCI.0b013e31827eecc6"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra041867"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aei210"},{"key":"e_1_2_6_5_1","volume-title":"Stockley's drug interactions","author":"Baxter K"},{"key":"e_1_2_6_6_1","unstructured":"UK Medicines Information National Institute for Health and Care Excellence.What is the risk of interaction between opioid analgesics and monoamine oxidase inhibitors MAOIs)?Available fromhttp:\/\/www.evidence.nhs.ukon. 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