From the Guidelines
Serotonin syndrome can be treated with medications such as cyproheptadine, a serotonin2A antagonist, and benzodiazepines for agitation.
Treatment Options
- Cyproheptadine: The adult dosage of cyproheptadine is usually 12 to 24 mg over 24 hours, typically starting with 12 mg, followed by 2 mg every 2 hours for continuing symptoms, and a maintenance dose of 8 mg every 6 hours, given orally 1.
- Benzodiazepines: May be useful in controlling muscular activity in moderate cases and treating agitation 1.
Additional Considerations
- Supportive care: Discontinuing the precipitating agent and providing supportive care, such as treatment of hyperthermia and management of autonomic instability, is crucial in managing serotonin syndrome 1.
- Close observation: Patients with serotonin syndrome can deteriorate rapidly, and close observation and preparation for rapid intervention may be necessary 1.
From the Research
Medications for Treating Serotonin Syndrome
The following medications can be used to treat serotonin syndrome:
- Benzodiazepines: may be used to treat agitation and tremor 2
- Cyproheptadine: may be used as an antidote 2, 3, 4, 5
- Dexmedetomidine: may be used as adjunctive therapy for cases of severe serotonin syndrome that are refractory to standard treatment 6
- Chlorpromazine: may be effective in the treatment of serotonin syndrome, although the evidence is limited 3
Dosage and Administration
- Cyproheptadine: the dose necessary to ensure blockade of brain 5-HT2 receptors is 20-30 mg, although lower doses (4-8 mg) have been used in some cases 3, 4
- Cyproheptadine: a total dose of 188 mg over 10 days has been used in one case without any side effects 5