A patient has been taking fluoxetine (Prozac) for depression and comes to the clinic to report nausea and jitteriness. The primary care NP notes tremors and sees that the patient is confused. The patient has a heart rate of 95 beats per minute
The NP should: a. change to bupropion (Wellbutrin).
b. ask the patient about other medications.
c. discontinue the fluoxetine immediately.
d. add mirtazapine (Remeron) to treat anxiety.
B
Serotonin syndrome is a potentially lethal set of symptoms such as these. The NP should evaluate whether the patient is taking other SSRIs, monoamine oxidase inhibitors, bupropion, serotonin-norepinephrine reuptake inhibitors, or other medications that can precipitate this. Changing medication is not indicated. Patients should never abruptly discontinue an SSRI. Adding mirtazapine is not indicated.
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