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This rare but potentially fatal syndrome can occur as the result of an interaction between MAOIs and drugs that have strong serotonergic effects, for example, other antidepressants, synthetic opioids, and some triptan migraine medications.24,34 To avoid serotonin syndrome, contraindicated medications should not be taken for 1 to 2 weeks before initiating therapy with the MAOI or for 2 weeks after stopping MAOI therapy

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Because these synthetic peptides are manufactured cheaply using bacterial proteins, even a batch advertised at 99% purity contains a 1% remainder of bacterial protein toxicity

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Allen JG, Harder J, Hernandez E, et al