Primary prevention
Agents that increase central nervous system serotonin levels via different pharmacologic mechanisms should never be prescribed together (e.g., a monoamine oxidase inhibitor [MAOI] plus a selective serotonin-reuptake inhibitor [SSRI]). Agents that act on the same serotonergic pathway should rarely be prescribed together (e.g., SSRI plus tramadol or meperidine).[14] Prescribing more than one serotonergic agent at a time is recommended only in situations where the therapeutic benefit clearly outweighs the risks of serotonin toxicity. However, a regimen that features only one serotonergic agent must be trialed (and shown to be safe, albeit subtherapeutic) first.
Patients prescribed serotonergic agents should be provided with information about serotonin toxicity and warned about other medications that should be avoided while they are taking these medications.[20] Patients should be asked about over the counter and complementary medicines to better evaluate potential drug-drug interactions.
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