Triptan-SSRI interaction may cause serotonin toxicity
Doctors in Queensland have warned about the possibility of triptans interacting with SSRI antidperessants to cause serotonin toxicity. In a case report they describe how a 30-year old woman with depression on regular fluvoxamine developed serotonergic symptoms such as motor symptoms , agitation and tachycardia shortly after taking the first dose of sumatriptan that she had been prescribed for migraine.
When she presented at the ED, the woman had right-sided facial and lower limb twitching, was tachycardic, diaphoretic, and hypertonic on initial assessment with bilateral lower limb and ocular clonus. Electrocardiogram showed sinus tachycardia. Her condition improved following supportive treatment, including an overnight stay in hospital for observation with slow intravenous fluids as well as the cyproheptadine, a potent antihistamine and serotonin antagonist. She was told to withhold her fluvoxamine for 24 hours and to avoid taking any further concomitant triptan medication
The report authors said the risk of drug interaction between SSRIs and 5-HT agonists was thought to be low because serotonin syndrome is more heavily mediated by serotonin 1A or 2A receptors, for which triptans have only a low affinity.
However, as this case shows, there was some risk and therefore clinicians “should counsel patients on the potential for drug interaction, and also have a clinical index of suspicion in patients presenting with serotoninergic symptoms who are on such medications,” they advised.
Doctor wins $450k damages for maliciously false reviews
A Sydney surgeon has been awarded $450,000 in defamation damages from a woman who mounted a campaign of online abuse and false claims against him after he refused to operate on her.
Dr Warwick Nettle, a Bondi-based plastic and reconstructive surgeon, became the target of virulent abuse, falsehoods and negative reviews from Catherine Cruse in 2018 when he declined to perform surgery on her, based on warnings from another surgeon who had previously treated her.
Dr Nettle took his case to the Federal Court of Australia, which found that his behaviour was professionally appropriate and justifiable, and that the online comments and maliciously false reviews reviews had seriously damaged both his professional reputation and his thriving practice.
As a results of Ms Cruse posting negative reviews, Dr Nettle’s “Google rating” fell from 5 to 3.5 stars and his workload declined significantly.
The court awarded damages of $450,000 to Dr Nettle and granted permanent injunctions barring Ms Cruse from posting further false and defamatory material about him. However Ms Cruse did not take part in the proceedings and could not be traced, having apparently deliberately concealed her whereabouts, the court was told.
Hospital contains neurology ward Delta cluster
A Sydney hospital cluster of COVID-19 Delta infections that spread through in staff working across neurology and geriatric wards has affected 29 patients, of whom seven have died, according to media reports.
The outbreak at Liverpool Hospital in western Sydney has led to highly restrictive and stressful conditions, with hospital staff now working in full PPE and patients in isolation with no visits allowed, said Professor Miriam Levy, chair of the staff medical council at the hospital,
“Teams can no longer go down to the ED to see often the sickest, most unstable patients because if you bring the whole team down, a senior clinician, a registrar, a junior doctor and a medical student, that’s putting too many people in the ED,” she told the News Corp.
“It has not spread through the whole of Liverpool Hospital so that tells you the systems we have are pretty good, people are changing their gear between wards,” added Professor Levy, who said it showed why the whole community should get vaccinated immediately.