Bettina C. Prator


J Neurosci Nurs. 2006;38(2):102-105. 

In This Article


Early diagnosis and prompt initiation of treatment are important in the treatment of serotonin syndrome. Management strategies include elimination of the precipitating agents and supportive measures to control agitation, hyperthermia, and autonomic dysfunction, which are commonly manifested as fluctuations in blood pressure and heart rate (Boyer & Shannon, 2005). Fatal complications such as seizures, coma, hypotension, ventricular arrhythmias, disseminated intravascular coagulation, rhabdomyolysis, metabolic acidosis, and renal failure may occur. The nurse should be vigilant about recognizing such potential problems and prepared to intervene promptly and appropriately. In severe cases, cardiopulmonary support is necessary with endotracheal intubation and mechanical ventilation, sedation, neuromuscular paralysis, and use of intravenous fluids and vasoactive drugs.

As Sternbach (2003) emphasized, no prospective studies have been done to evaluate pharmacological treatment. Current strategies are based on anecdotal reports of human cases and literature on animal models. Benzodiazepines are commonly used to achieve sedation and reduce muscle rigidity, although the addition of nondepolarizing paralyzing agents may be necessary as second-line therapy. The use of agents known to have nonspecific antiserotonergic actions, such as cyproheptadine, chlorpromazine, methysergide, and propanolol, has been advocated, although their efficacy in humans has not been established (Graudins, Stearman, & Chan, 1998). Specifically, cyproheptadine, a histamine-1 receptor antagonist approved by the Food and Drug Administration as an antihistamine to treat allergic conditions, was noted to reduce experimentally induced hyperserotonergic signs in animals and has been commonly used in the treatment of serotonin syndrome. McDaniel (2001) reported three cases of serotonin syndrome and reiterated that cyproheptadine reduced the severity of signs and symptoms but did not alter the time required for resolution. In addition, Chan et al. (1998) wrote that cyproheptadine does not have any dopamine antagonist properties and thus can be safely administered in cases in which NMS cannot be differentiated from serotonin syndrome.


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