Severe Serotonin Syndrome Causing Sudden Breathing Failure After Using Ayahuasca and Dextromethorphan

A 46-year-old man experienced severe serotonin syndrome after using ayahuasca combined with over-the-counter medications.

• Ayahuasca contains monoamine oxidase inhibitors and N,N-dimethyltryptamine, which may lead to serotonergic toxicity.
• The patient developed acute respiratory failure requiring intubation and intensive care after consuming ayahuasca with dextromethorphan and diphenhydramine.
• Management included intravenous benzodiazepines and oral cyproheptadine, resulting in rapid clinical improvement.
• This case is the first documented instance of severe serotonin syndrome from the combination of ayahuasca and these over-the-counter medications.
• There is a need for increased awareness among clinicians regarding the risks of combining ayahuasca with other serotonergic agents.

Simplified