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Serotonin Syndrome

In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan–.

Serotonin Syndrome

Leslie V. Simon et al.


Serotonin syndrome is a potentially life-threatening condition precipitated by the use of serotonergic drugs. It may be a consequence of therapeutic medication use, accidental interactions between medications or recreational drugs, or intentional overdose. Symptoms can range from mild to fatal and classically include altered mental status, autonomic dysfunction, and neuromuscular excitation. Several criteria exist for making this clinical diagnosis, but the Hunter criteria are generally accepted as the most accurate. The diagnosis can be made in patients with a history of exposure to a serotonergic drug plus one or more of the following: spontaneous clonus, inducible clonus with agitation and diaphoresis, ocular clonus with agitation and diaphoresis, tremor and hyperreflexia, hypertonia, temperature over 38 C with ocular or inducible clonus. Management consists of immediate discontinuation of serotonergic agents, hydration, and supportive care to manage blood pressure, hyperpyrexia, and respiratory and cardiac complications. Sedation is best facilitated with benzodiazepines. Refractory cases may respond to the antidote, cyproheptadine, which must be given orally or via gastric tube. The effectiveness of cyproheptadine is unproven, but multiple case reports support its use in patients who do not respond to sedation and supportive care.

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