TABLE 1

Drug mechanisms associated with serotonin syndrome

Mechanism	Specific agents
Decreased serotonin breakdown	Monoamine oxidase inhibitors^a: phenelzine, tranylcypromine, isocarboxazid, moclobemide, selegiline, rasagiline Antibiotics: linezolid, tedizolid Others: methylene blue, procarbazine, Syrian rue
Decreased serotonin reuptake	Antidepressants: Selective serotonin reuptake inhibitors^a : fluoxetine, fluvoxamine, paroxetine, citalopram, sertraline, escitalopram Serotonin-norepinephrine reuptake inhibitors^a: venlafaxine, duloxetine, milnacipran Tricyclic antidepressants^a: clomipramine, imipramine St. John’s wort Opioids^a: meperidine, buprenorphine, tramadol, tapentadol, dextromethorphan Antiepileptics: valproate, carbamezapine Antiemetics: ondansetron, granisetron, metoclopramide
Increased serotonin precursors or agonists	Tryptophan, lithium, fentanyl, lysergic acid diethylamide (LSD)
Increased serotonin release	Central nervous system stimulants: amphetamines^a Anorectics^a: fenfluramine, dexfenfluramine, phentermine Drugs of abuse: methylenedioxymethamphetamine (ecstasy),^a cocaine
CYP2D6 and CYP3A4 inhibitors	Antibiotics: erythromycin, ciprofloxacin Antifungal: fluconazole Antiretroviral: ritonavir

↵a Confirmed to precipitate serotonin syndrome. The others have not been reliably confirmed and are based on case reports or expert opinion.