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Drug interactions resulting in serotonin syndrome can occur while switching serotonergic pharmacologic agents when an insufficient time lag occurs before initiating the alternative therapy. Residual pharmacologic effect, receptor downregulation or upregulation, and the presence of active metabolites may be causative in these circumstances. Symptoms of serotonin syndrome include altered mental status, agitation, myoclonus, hyperreflexia, diaphoresis, tremor, diarrhea, incoordination, muscle rigidity, and hyperthermia.

Tobacco use for many is a classical addictive disorder with the behavior pattern of compulsive drug use despite adverse psychosocial and health consequences. Dopamine is the key neurotransmitter of the mesolimbic system reinforced by nicotine stimulation. Some research suggests that the effects of nicotine may have similar results to antidepressants. This may explain the shared benefit of cessation. Both genetic and environmental factors are important to develop regular tobacco use. 70 genetic predisposition.

This syndrome was first described in patients treated with MAOIs who were given other drugs that enhance serotonergic activity. However, ingestion of an MAOI is not required for this syndrome to develop, and its development is unpredictable. Drug interactions resulting in serotonin syndrome can occur while switching serotonergic pharmacologic agents when an insufficient time lag occurs before initiating the alternative therapy. Residual pharmacologic effect, receptor downregulation or upregulation, and the presence of active metabolites may be causative in these circumstances.

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