Drug-Induced Serotonin Syndrome

Bartlett, Dana

doi:10.4037/ccn2017169

Cited by 39 publications

(53 citation statements)

References 39 publications

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“…Current first line therapy for serotonin syndrome involves discontinuing offending agents and supportive care measures . These may include benzodiazepines for treatment of muscle agitation and tremor, fluid replacement and external cooling measures to treat fever.…”

Section: Discussionmentioning

confidence: 99%

“…Case reports and series of clinical improvement support cyproheptadine use as a reversal agent for serotonin syndrome . However it is difficult to assess the effectiveness of cyproheptadine in the management of serotonin syndrome in a non‐controlled trial or case report.…”

Section: Discussionmentioning

confidence: 99%

“…Signs and symptoms associated with serotonin syndrome were based on the Hunters or Sternbach's criteria for serotonin syndrome . Signs and symptoms were recorded for each case and based on the mention of “sweating” for diaphoresis, hypertension (BP > 120/80), hyperthermia (>38°C or 100.4 F) and tachycardia (HR > 100) in case notes.…”

Section: Methodsmentioning

confidence: 99%

“…Symptoms usually resolve within 24 hours with agent discontinuation and supportive care. However, signs and symptoms can last for several days and progress to life‐threatening hyperthermia, rhabdomyolysis and seizures …”

Section: Introductionmentioning

confidence: 99%

“…However, signs and symptoms can last for several days and progress to life-threatening hyperthermia, rhabdomyolysis and seizures. [1][2][3] Cyproheptadine is a first-generation histamine (H-1) receptor antagonist with non-selective serotonergic antagonistic activity. 4,5 Because serotonin syndrome is associated with excess stimulation of central and peripheral serotonin (5-HT1A and 5-HT2A) receptors, the antagonism of this activity is thought to relieve the manifestations of a serotonin syndrome.…”

Section: Introductionmentioning

confidence: 99%

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An 11-year retrospective review of cyproheptadine use in serotonin syndrome cases reported to the California Poison Control System

et al. 2019

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Summary What is known Cyproheptadine is a serotonin and histamine antagonist that has been suggested as a treatment for serotonin syndrome in case reports. Objective We sought to examine the differences between outcomes and treatment recommendations in patients who received and did not receive cyproheptadine for a probable serotonin syndrome. Methods A retrospective review of cases reported to the California Poison Control System between 2006 and 2017 involving cyproheptadine administration or consideration for treatment of a probable serotonin syndrome. Results and discussion A total of 1420 cases were identified and 288 cases met the inclusion criteria. Of these, 68 (23.1%) patients received cyproheptadine treatment and were significantly older (mean age 49.7 vs 33.5 years, P < 0.00001), intubated (n = 35, 51% vs n = 62, 28%, P < 0.05) and, although not statistically significant, were more frequently admitted to a critical care unit (n = 56, 82.3% vs n = 154, 70.0%, P = 0.09). There were no significant differences in serious outcomes (moderate or worse effects) or hospitalization rates (OR, 1.09, 95% CI, 0.49‐2.64 and OR, 1.99, 95% CI, 0.86‐4.58). There were eight fatalities, of which two patients received cyproheptadine. All fatalities were acute polypharmacy ingestions and had manifested severe symptoms (seizures, hypotension or hyperthermia) either prior to the administration or consideration of cyproheptadine therapy. Cyproheptadine was not administered in 138 (48%) cases primarily due to minimal clinical severity and patient improvement (43%), and not recommended in 82 (28%) cases for reasons from waiting for response to other supportive measures (30%), limited evidence of efficacy (28%) and undetermined diagnosis (14.6%). What is new and conclusion The benefits of and indications for cyproheptadine are uncertain and questionable for the management of a serotonin syndrome. Future recommendations on its use should be based on diagnostic criteria, severity of symptoms and management in conjunction with other supportive measures.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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An 11-year retrospective review of cyproheptadine use in serotonin syndrome cases reported to the California Poison Control System

et al. 2019

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Serotonin syndrome due to concomitant use of linezolid and methadone

Masbough

Roshanzamiri

Rahimi

et al. 2022

Clinical Case Reports

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Serotonin syndrome is a potentially life-threatening adverse drug reaction typically caused by a single or combination of two or more medications with serotonergic properties due to increased serotonin release. Our case is a 60-year-old drug-addict man who was admitted to the poisoning department of Loghman hospital with methadone poisoning. On the fifth day of hospitalization and after initiating the linezolid treatment for VAP, the patient began to run a fever with agitation, tremor, spontaneous clonus movement in the hands, and tachycardia.Due to patients' manifestations and after ruling out other diagnoses, serotonin syndrome was confirmed with the possibility of concomitant use of linezolid and methadone. Linezolid administration was promptly discontinued, and vancomycin therapy was initiated (1000 mg twice a day intravenously). Supportive therapies were performed. Finally, tremor, rigidity, and clonus movement disappeared within 48 h.

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Clinical Pharmacogenetics Implementation Consortium (CPIC) Guideline for CYP2D6, CYP2C19, CYP2B6, SLC6A4, and HTR2A Genotypes and Serotonin Reuptake Inhibitor Antidepressants

Bousman

Stevenson

Ramsey

et al. 2023

Clin Pharma and Therapeutics

108

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Serotonin reuptake inhibitor antidepressants, including selective serotonin reuptake inhibitors (SSRIs; i.e., citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, and sertraline), serotonin and norepinephrine reuptake inhibitors (i.e., desvenlafaxine, duloxetine, levomilnacipran, milnacipran, and venlafaxine), and serotonin modulators with SSRI-like properties (i.e., vilazodone and vortioxetine) are primary pharmacologic treatments for major depressive and anxiety disorders. Genetic variation in CYP2D6, CYP2C19, and CYP2B6 influences the metabolism of many of these antidepressants, which may potentially affect dosing, efficacy, and tolerability. In addition, the pharmacodynamic genes SLC6A4 (serotonin transporter) and HTR2A (serotonin-2A receptor) have been examined in relation to efficacy and side effect profiles of these drugs. This guideline updates and expands the 2015 Clinical Pharmacogenetics Implementation Consortium (CPIC) guideline for CYP2D6 and CYP2C19 genotypes and SSRI dosing and summarizes the impact of CYP2D6, CYP2C19, CYP2B6, SLC6A4, and HTR2A genotypes on antidepressant dosing, efficacy, and tolerability. We provide recommendations for using CYP2D6, CYP2C19, and CYP2B6 genotype results to help inform prescribing these antidepressants and describe the existing data for SLC6A4 and HTR2A, which do not support their clinical use in antidepressant prescribing.This document updates and expands the 2015 Clinical Pharmacogenetics Implementation Consortium (CPIC) guideline for CYP2D6 and CYP2C19 genotypes and selective serotonin reuptake inhibitor (SSRI) antidepressants. 1 The current guideline includes updated evidence reviews for SSRIs, as well as evidence reviews for serotonin and norepinephrine reuptake inhibitors

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Drug-Induced Serotonin Syndrome

Cited by 39 publications

References 39 publications

An 11-year retrospective review of cyproheptadine use in serotonin syndrome cases reported to the California Poison Control System

An 11-year retrospective review of cyproheptadine use in serotonin syndrome cases reported to the California Poison Control System

Serotonin syndrome due to concomitant use of linezolid and methadone

Clinical Pharmacogenetics Implementation Consortium (CPIC) Guideline for CYP2D6, CYP2C19, CYP2B6, SLC6A4, and HTR2A Genotypes and Serotonin Reuptake Inhibitor Antidepressants

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