From the Guidelines
Treatment for Serotonin Syndrome involves discontinuing the precipitating agent and providing supportive care.
Supportive Care
- Treatment of agitation (eg, benzodiazepines)
- Amelioration of hyperthermia
- Management of the autonomic instability (eg, IV fluids and other agents to address abnormal vital signs)
Severe Cases
- Emergency sedation, neuromuscular paralysis, and intubation may be considered for those with severe serotonin syndrome (eg, temperature >41.1°C) 1
- Cyproheptadine, a serotonin2A antagonist, may be considered, with a typical adult dosage of 12 to 24 mg over 24 hours, 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
Important Considerations
- Physical restraints may be detrimental, as they may exacerbate isometric contractions, worsening hyperthermia and lactic acidosis, and increasing mortality 1
- Management of hyperthermia often involves terminating the extreme muscle activity, and benzodiazepines may be useful in controlling muscular activity in moderate cases 1
- In severe cases, paralysis with nondepolarizing drugs (eg, vecuronium or rocuronium) and intubation may be considered 1
From the Research
Treatment Overview
The treatment for Serotonin (5-hydroxytryptamine) syndrome involves several key steps:
- Withdrawal of the offending agent(s) [ 2, 3,4,5,6 ]
- Aggressive supportive care to treat hyperthermia and autonomic dysfunction [ 2, 3,5,6 ]
- Administration of serotonin antagonists, such as cyproheptadine or chlorpromazine, in some cases [ 2, 4,5,6 ]
- Use of benzodiazepines to control agitation and muscle rigidity in severe cases 6
Supportive Care
Supportive care measures include:
- Hemodynamic stabilization 5
- Sedation 5
- Temperature control 5
- Hydration 5
- Monitoring for complications 5
- Intravenous fluids and electrolytes 6
Hospitalization
Patients with moderate and severe cases of Serotonin syndrome require inpatient hospitalization [ 2 ].