Treatment of the serotonin syndrome with cyproheptadine

Graudins, Andis; Stearman, Andrew; Chan, Betty

doi:10.1016/s0736-4679(98)00057-2

Cited by 249 publications

(152 citation statements)

References 17 publications

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“…Recommended adult dosing includes an initial dose of 12 mg followed by 2 mg every two hours during symptoms. Pediatric dosing advice has been published, with a recommended dose of 0.25 mg/kg/day, divided into two to three doses but this regimen does not begin with a large loading dose which has been suggested as necessary for treatment of SS in adults; therefore we started treatment with an 8 mg dose in our case (2,14,15). In addition to cyproheptadine, benzodiazepines were also used among other cases, including our patient, to reduce hyperflexia and tremor (8,11).…”

Section: Discussionmentioning

confidence: 99%

Serotonin syndrome following a single 50 mg dose of sertraline in a child

Phan

Casavant

Crockett

et al. 2008

Clinical Toxicology

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Objective. To report a case of serotonin syndrome associated with a single, 50 mg dose of sertraline in a child and discuss the findings in context with previous relevant literature involving other selective serotonin reuptake inhibitors used in children. Case Summary. A nineyear old male with chronic behavioral problems was prescribed oral sertraline 50 mg daily. After the first dose, the patient presented with abdominal pain, seizure-like activity, and change in mental status. He was admitted to a tertiary-care pediatric hospital and was treated for serotonin syndrome. Laboratory findings of elevated creatine kinase and serum creatinine were consistent with rhabdomyolysis as result of continued hypertonicity. Sertraline was discontinued and treatment with lorazepam and cyproheptadine was initiated. Clinical status, creatine kinase, and serum creatinine improved over 5 days of hospitalization. The Adverse Drug Reaction Probability Scale by Naranjo et al was applied to assess causality. The scale indicated the association of a single dose of sertraline and serotonin syndrome as "probable." Conclusion. To our knowledge this is the first reported case of serotonin syndrome associated with a single dose of sertraline in a child using a validated causality scale. The sertraline 50 mg dose given to the child was higher than usual recommended initial doses (25 mg). This potential adverse reaction should be considered when selecting antidepressant therapy for children.

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Section: Discussionmentioning

confidence: 99%

Serotonin syndrome following a single 50 mg dose of sertraline in a child

Phan

Casavant

Crockett

et al. 2008

Clinical Toxicology

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show abstract

“…Additional management of serotonin syndrome includes supportive care and benzodiazepines for sedation. Patients with more severe cases of serotonin syndrome may benefi t from the use of the serotonin receptor antagonist cyproheptadine (4 mg three times daily) ( 11 ). Patients with autonomic instability and severe hyperthermia (temperature <41°C) should be managed in the intensive care unit.…”

Section: Discussionmentioning

confidence: 99%

Linezolid-Induced Serotonin Toxicity in a Patient Not Taking Monoamine Oxidase Inhibitors or Serotonin Receptor Antagonists

Sutton¹,

Stroup²,

Som³

2016

Baylor University Medical Center Proceedings

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“…Patients with suspected serotonin syndrome are generally managed with withdrawal of the offending agent(s) and symptomatic and supportive care but can also be treated with the serotonin receptor antagonist cyproheptadine [18]. Evidence for its effectiveness, however, is limited to some animal data and case reports [19][20][21]. Cyproheptadine may be of limited usefulness in severe serotonin syndrome as most positive reports of its effectiveness have been in more mild cases.…”

Section: Discussionmentioning

confidence: 99%

Citalopram Overdose: a Fatal Case

Kraai

Seifert

2014

J. Med. Toxicol.

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Background Citalopram is a selective serotonin reuptake inhibitor (SSRI) with cardiac and neurologic toxicities as well as the potential for serotonin syndrome. In most instances, patients recover fully from toxic ingestions of SSRIs. We describe a fatal case of a citalopram overdose. Case Report A 35-year-old woman presented to the emergency department after having witnessed seizures at home. An empty citalopram prescription bottle was located, and an intentional overdose was suspected. At the scene, she was found to be in cardiac arrest with pulseless electrical activity and underwent cardiopulmonary resuscitation, including intravenous epinephrine and bicarbonate. In the emergency department, her physical exam was notable for cough and gag reflexes and movement in all extremities with increased muscle tone and tachycardia. Her initial postresuscitation ECG showed sinus rhythm with QRS 92 ms and QTc 502 ms. Her temperature was initially normal, but she rapidly became febrile to 41.8°C shortly after admission. She was treated symptomatically and with cyproheptadine for suspected serotonin syndrome (SS) but became increasingly hemodynamically unstable over the next 6 h and then developed torsades des pointes (TdP) progressing to pulseless, wide complex tachycardia. She underwent cardiopulmonary resuscitation (CPR) for approximately 50 min but ultimately expired. Postmortem serum analysis revealed a citalopram concentration of 7300 ng/mL (therapeutic range 9-200 ng/mL) and THC, but no other nonresuscitation drugs or substances. Case Discussion Citalopram overdoses often have only mild to moderate symptoms, particularly with ingestions under 600 mg in adults. However, with higher doses, severe manifestations have been described, including QTc prolongation, TdP, and seizures. Serotonin syndrome has also been described in SSRI overdose, and our patient exhibited signs consistent with SS, including increased muscle tone and autonomic dysregulation. Our patient's serum concentration suggests a massive overdose, with major clinical effects, possible SS, and death. Conclusions Although most patients recover from citalopram overdose, high-dose ingestions can produce severe effects and fatalities may occur. In this case, it is likely that the patient's delayed presentation also contributed significantly to her death. The clinician must be aware of the potential for large ingestions of citalopram to produce life-threatening effects and monitor closely for the neurologic, cardiovascular, and other manifestations that, in rare cases, can be fatal.

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Treatment of the serotonin syndrome with cyproheptadine

Cited by 249 publications

References 17 publications

Serotonin syndrome following a single 50 mg dose of sertraline in a child

Serotonin syndrome following a single 50 mg dose of sertraline in a child

Linezolid-Induced Serotonin Toxicity in a Patient Not Taking Monoamine Oxidase Inhibitors or Serotonin Receptor Antagonists

Citalopram Overdose: a Fatal Case

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