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Serotonin Syndrome
Treatment of Serotonin Syndrome
Supportive measures Sometimescyproheptadine When serotonin syndrome is recognized and treated promptly, the prognosis is usually good ( Key Points ). All serotonergic drugs should be stopped. Mild symptoms are often relieved with sedation using a benzodiazepine, with resolution occurring in 24 to 72 hours. If symptoms resolve more rapidly, patients should be observed for at least several hours. However, most patients require hospitalization for further testing, treatment, and monitoring. In severe cases, admission to an intensive care unit is required. Hyperthermia is treated by cooling (see Treatment ). Neuromuscular blockade with appropriate sedation, muscle paralysis, and other supportive measures may be necessary. Drug treatment of autonomic abnormalities (eg, hypertension, tachycardia) should be with shorter-acting drugs (eg, If symptoms persist despite supportive measures, the serotonin antagonistcyproheptadinecan be given orally or, after crushing, via nasogastric tube (12 mg, then 2 mg every 2 hours until response occurs). Consultation with a toxicologist is encouraged and can be accomplished by calling the United States Poison Control Network (1-800-222-1222). 1.Boyer EW, Shannon M: The serotonin syndrome.N Engl J Med352(11):1112-20, 2005. doi: 10.1056/NEJMra041867 Erratum in:N Engl J Med356(23):2437, 2007. Erratum in:N Engl J Med361(17):1714, 2009. 