Paroxetine-perphenazine overdose-induced serotonin syndrome

A patient who developed serotonin syndrome a few hours after ingestion of paroxetine and perphenazine in an attempt to commit suicide is described. Ingestion of both drugs was confirmed by analytical detection in blood. The syndrome presented with fluctuating levels of consciousness, agitation, restlessness, severe myoclonus, hyperreflexia, diaphoresis, hyperpyrexia, disseminated intravascular coagulation, elevated creatine kinase and myoglobinuria. The patient was treated successfully with supportive care clonazepam and cyproheptadine, with resolution of symptoms within 72 h. This case is unique because it highlights the potential risk of overdose with paroxetine and perphenazine in inducing serotonin syndrome.