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Treatments and drugs
By Mayo Clinic staffTreatment of serotonin syndrome depends on the severity of your symptoms.
- If your symptoms are minor, a visit to the doctor and stopping the medication causing the problem may be enough.
- If you have symptoms that concern your doctor, you may need to go to the hospital. Your doctor may have you stay in the hospital for several hours to make sure you're OK.
- If you have severe serotonin syndrome, you may need additional medications and longer hospitalization.
Depending on your symptoms, you may receive the following treatments:
- Muscle relaxants. Benzodiazepines, such as diazepam (Valium) or lorazepam (Ativan), can help control agitation, seizures and muscle stiffness.
- Serotonin-production blocking agents. If other treatments aren't working, medications such as cyproheptadine can help by blocking serotonin production.
- Oxygen and intravenous (IV) fluids. Breathing oxygen through a mask helps maintain normal oxygen levels in your blood, and IV fluids are used to treat dehydration and fever.
- Drugs that control heart rate and blood pressure. These may include esmolol (Brevibloc) or nitroprusside (Nitropress), to reduce a high heart rate or high blood pressure. If your blood pressure is too low, your doctor may give you phenylephrine (Neo-Synephrine) or epinephrine.
- A breathing tube and machine and medication to paralyze your muscles. These may be necessary if you have a high fever.
Serotonin syndrome symptoms usually go away within 24 hours of stopping medications that increase serotonin, and taking medications to block the effects of serotonin already in your system if they're needed. However, symptoms of serotonin syndrome caused by some antidepressants could take several weeks to go away completely. These medications remain in your system longer than other medications that can cause serotonin syndrome.
- Moore DP. Serotonin syndrome. In: Moore DP. Moore & Jefferson: Handbook of Medical Psychiatry. 2nd ed. Philadelphia Pa.: Mosby; 2004. http://www.mdconsult.com/das/book/body/113440701-3/0/1243/148.html#4-u1.0-B0-323-02911-6..50148-2_1373. Accessed Dec. 10, 2008.
- Bilden EF, et al. Antidepressants. In: Marx JA: Rosen's Emergency Medicine: Concepts and Clinical Practice. 6th ed. Philadelphia Pa.: Elsevier; 2006. http://www.mdconsult.com/das/book/body/113410207-5/0/1365/463.html#4-u1.0-B0-323-02845-4..50154-2--cesec45_7826. Accessed Dec. 10, 2008.
- Boyer EW, et al. Serotonin syndrome. New England Journal of Medicine. 2005;352:1112.
- Combined use of 5-hydroxytryptamine receptor agonists (triptans), selective serotonin reuptake inhibitors (SSRIs) or selective serotonin/norepinephrine reuptake inhibitors (SNRIs) may result in life-threatening serotonin syndrome. US Food and Drug Administration. http://www.fda.gov/Cder/Drug/advisory/SSRI_SS200607.htm. Accessed Dec. 10, 2008.
- Zeping H, et al. Herb-drug interactions. Drugs. 2005;65:1239.
- Chyka PA, et al. Dextromethorphan poisoning: An evidence-based consensus guideline for out-of-hospital management. Clinical Toxicology. 2007;45:662.
- Argwal P. Serotonin syndrome. In: Ferri's Clinical Advisor 2009. Philadelphia, Pa.: Mosby Elsevier; 2009. http://www.mdconsult.com/das/book/body/113440701-3/0/1701/541.html#4-u1.0-B978-0-323-04134-8..50022-7--subchapter15_11410. Accessed Dec. 10, 2008
