HelixTalk Episode #63 - More is not always better - Story of Serotonin Syndrome

Date posted: July 4, 2017, 6:00 am

In this episode, we discuss several aspects of serotonin syndrome including the typical clinical presentation, its etiology and common drug-induced combinations, and how to appropriately manage the syndrome.

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Key Concepts

1. Patient history and thorough clinical evaluation are very important in diagnosing serotonin syndrome. Use of the Hunter Criteria is recommended.
2. Clinicians and patients should be well informed about drug combinations that can lead to serotonin syndrome.  Having a well-informed patient can cause symptoms to be caught early on before they become more severe.
3. The most common signs and symptoms of serotonin syndrome are mental status changes (ranging from mild restlessness to severe delirium), neuromuscular hyperactivity (mild tremors to severe muscular rigidity), and autonomic manifestations (diaphoresis, BP and HR fluctuations, and nausea and vomiting).
4. The most important steps in treating serotonin syndrome is to discontinue most or all serotonergic agents followed by supportive care, benzodiazepines, and possibly serotonin antagonist therapy (cyproheptadine) based on severity.
5. Careful consideration should be given to decide if any of the serotonergic agents need to be restarted following an episode of serotonin syndrome.

References

1. Volpi-Abadie J, Kaye AM, Kaye AD. Serotonin syndrome. Ochsner J. 2013 Winter;13(4):533-40.
2. Abadie D, Rousseau V, Logerot S, et al. Serotonin Syndrome: Analysis of Cases Registered in the French Pharmacovigilance Database. J Clin Psychopharmacol. 2015 Aug;35(4):382-8.
3. Boyer EW, Shannon M. The serotonin syndrome. N Engl J Med. 2005 Mar 17;352(11):1112-20.