TY - JOUR T1 - Serotonin syndrome caused by drug to drug interaction between escitalopram and dextromethorphan JF - BMJ Case Reports DO - 10.1136/bcr-2017-221486 VL - 2017 SP - bcr-2017-221486 AU - Prudence Dy AU - Victor Arcega AU - Wael Ghali AU - Winifred Wolfe Y1 - 2017/08/05 UR - http://casereports.bmj.com/content/2017/bcr-2017-221486.abstract N2 - A 63-year-old woman with a history of long-standing depression, maintained on escitalopram, presented with altered mental status. Patient had recently been prescribed dextromethorphan-promethazine cough syrup 2 weeks prior for an upper respiratory tract infection. On admission, she was lethargic and obtunded and found to have inducible myoclonus on examination. The rest of her physical exam was unremarkable. Pertinent lab and imaging findings showed QTc prolongation on ECG, negative electroencephalogram and CT head findings, essentially normal blood tests and a negative toxicology screen. The patient was admitted to the step down unit for close observation; both escitalopram and the cough syrup were suspended and was supportively managed. Overnight the patient's mental status improved and the serial EcGs showed resolution of the prolonged QTc. Patient was discharged home without further complication. ER -