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Serotonin syndrome symptoms may include mental status changese.gagitationhallucinationsdeliriumand comaautonomic instabilitye.gtachycardialabile blood pressuredizzinessdiaphoresisflushinghyperthermianeuromuscular symptomse.gtremorrigiditymyoclonushyperreflexiaincoordinationseizuresand/or gastrointestinal symptomse.gnauseavomitingdiarrheaPatients should be monitored for the emergence of serotonin syndrome.

Escitalopram is metabolized to S-DCT and S-didemethylcitalopramS-DDCTIn humansunchanged escitalopram is the predominant compound in plasmaAt steady statethe concentration of the escitalopram metabolite S-DCT in plasma is approximately one-third that of escitalopramThe level of S-DDCT was not detectable in most subjectsIn vitro studies show that escitalopram is at least 7 and 27 times more potent than S-DCT and S-DDCTrespectivelyin the inhibition of serotonin reuptakesuggesting that the metabolites of escitalopram do not contribute significantly to the antidepressant actions of escitalopramS-DCT and S-DDCT also have no or very low affinity for serotonergic5-HT 1-7or other receptors including alphaand beta-adrenergicdopamineD 1-5histamineH 1-3muscarinicM 1-5and benzodiazepine receptorsS-DCT and S-DDCT also do not bind to various ion channels including NaKCl and Cachannels.

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