pharmacology

A. Baclofen

• Mechanism: GABA-B receptor agonist

• Use: Skeletal muscle relaxant; inhibits reflexes at the spinal cord level

• Adverse Effects:

  • Sedation

  • Dizziness

• Not associated with serotonin syndrome

🔹 B. Celecoxib

• Mechanism: Selective COX-2 inhibitor (NSAID)

• Use: Pain and inflammation, including acute low back pain

• Not associated with serotonin syndrome

🔹 C. Diazepam

• Mechanism: Binds to GABA-A receptors (benzodiazepine)

• Effects:

  • Sedative

  • Anxiolytic

  • Anticonvulsant

  • Muscle relaxant

• Adverse Effects:

  • Psychomotor impairment

  • Amnesia

  • Dependence

• Not serotonergic, so not linked to serotonin syndrome

🔹 D. Naproxen

• Mechanism: Nonselective COX-1 and COX-2 inhibitor (NSAID)

• Use: Common first-line for acute low back pain

• Not associated with serotonin syndrome

🔹 E. Tramadol ✅

• Mechanism:

  • Weak opioid receptor agonist

  • Inhibits serotonin & norepinephrine reuptake

• Risk: May cause serotonin syndrome, especially when combined with SSRIs (e.g., citalopram)

• Warning symptoms:

  • Diaphoresis

  • Restlessness

  • Tremors

  • Diarrhea