Drug-induced Serotonin Syndrome

Charles H. Brown, MS Pharm, RPh, CACP

Disclosures

US Pharmacist 

In This Article

Treatment

In general, treatment of SS first involves discontinuing the offending drug(s) and providing the patient with supportive care. Many mild-to-moderate SS cases are self-limiting and usually resolve within 24 to 72 hours.[19] Resolution of more severe cases will likely take much longer. In such cases, supportive care, drug discontinuation, and administration of medication (e.g., diazepam 5 mg IV to reduce hypertonicity and neurologic excitability) may be sufficient to resolve mild symptoms.[2,13,36] Patients with severe symptoms may need sedation, paralyzation, and intubation.

Administration of drugs with serotonin antagonist properties, such as cyproheptadine and chlorpromazine, has been utilized in a few patients.[4,16,18] Cyproheptadine 4 mg orally is the most widely used antidote for SS.[36] Although increased body temperature is common in patients with severe SS, antipyretic therapy usually is not recommended. This is because the fever that occurs with SS is caused by excessive muscular activity, not a change in the hypothalamic temperature set point.[2]

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