People who are taking antidepressant medications should not take 5-HTP without their provider's supervision. These medications could combine with 5-HTP to cause serotonin syndrome, a dangerous condition involving mental changes, hot flashes, rapidly fluctuating blood pressure and heart rate, and possibly coma.
Rarely, 5-HTP can cause a rapid or irregular heartbeat. High doses of 5-HTP or interactions with other drugs can cause a condition called serotonin syndrome.
Herbal supplements, including St. John's wort, ginseng and nutmeg. Over-the-counter cough and cold medications containing dextromethorphan (Delsym) Anti-nausea medications such as granisetron (Sancuso, Sustol), metoclopramide (Reglan), droperidol (Inapsine) and ondansetron (Zofran) Linezolid (Zyvox), an antibiotic.
Patients can manifest agitation, ocular clonus, tremor, akathisia, deep tendon hyperreflexia, inducible or spontaneous clonus, muscle rigidity, dilated pupils, and diaphoresis. Neuromuscular findings are typically more pronounced in the lower extremities. (See 'Clinical features' above.)
For mild serotonin syndrome, treatment involves discontinuing the offending agent and supportive therapy with intravenous fluids, correction of vital signs, and symptomatic treatment with a benzodiazepine. Patients should be admitted and observed for 12 to 24 hours to prevent exacerbation.
Administration of 5-HTP alone depletes catecholamines (dopamine, norepinephrine, and epinephrine). When dopamine depletion is great enough, 5-HTP will no longer function.
Large doses of 5-HTP, such as 6-10 grams daily, are possibly unsafe. These doses have been linked to severe stomach problems and muscle spasms. Some people who have taken 5-HTP have developed a serious health condition called eosinophilia-myalgia syndrome (EMS).
Serotonin toxicity most often happens when 2 or more serotonin-elevating drugs are used together, especially if they increase serotonin in different ways. An MAOI with an SSRI, an SNRI, or another MAOI is the riskiest combination, but other combinations can also result in toxicity.
5HTP (5-hydroxytryptophan) can increase the risk of serotonin syndrome: Supplements that contain serotonin or alter serotonin metabolism—such as 5HTP (a serotonin precursor), SAMe, or St. John's wort can cause (the potentially life-threatening) serotonin syndrome when taken with SSRIs.
Because many patients with serotonin syndrome are prone to episodes of hypomagnesemia, their serum magnesium levels should be checked routinely. If these levels are low, consult with the healthcare team to ensure oral or I.V. replacement magnesium is prescribed.
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