<prompt> A patient is on both Clomipramine and Escitalopram. We should monitor him forParkinsons diseaseSerotonin syndromeNeuroleptic malignant syndromeHyperpyrexia  <response>: B Serotonin syndrome Clomipramine oral Escitalopram oral both increase affecting serotonin levels in the blood. Too much serotonin is a potentially life-threatening situation. Severe signs and symptoms include high blood pressure and increased heart rate that lead to shock. Symptoms of this potentially dangerous Serotonin syndrome range from minimal in patients starting selective serotonin reuptake inhibitors SSRIs to fatal in those combining monoamine oxidase inhibitors MAOIs with serotonergic agents. Serotonin syndrome is characterized by changes in autonomic, neuromotor, and cognitive-behavioral function triggered by increased serotonergic stimulation. It typically results from pharmacodynamic andor pharmacokinetic interactions between drugs that increase serotonin activityRECOGNITION OF SEROTONIN SYNDROMESystemClinical Signs Symptoms AutonomicDiaphoresis, hyperthermia, hypertension, tachycardia, pupillary dilatation, nausea, diarrhea, shivering NeuromotorHyperreflexia, myoclonus, restlessness, tremor, incoordination, rigidity, clonus, teeth chattering, trismus, seizures Cognitive-behavioralConfusion, agitation, anxiety, hypomania, insomnia, hallucinations, headache Most Moclobemide-SSRI interactions--including fatalities--involved overdoses in suicide attempts, although toxic symptoms have been reported with clomipramine or meperidine taken at normal dosages. Switch medication from clomipramine to Escitalopram. Stop clomipramine Before day 1: Gradually reduce dosage of clomipramine to a maximum of 50 mgday. Day 1: Reduce dosage of clomipramine to 25 mgday. Day 3: Reduce dosage of clomipramine to 10 mgday. Day 8: Stop administration of clomipramine. Start Escitalopram Day 1: Simultaneously start administration of escitalopram in a normal dosage of 10 mgday. 