Key result
Cyproheptadine resolves severe hyperthermia, tachycardia, and diarrhea in critical serotonin syndrome.
Case Report (n=1)
A trial of cyproheptadine can be an effective diagnostic and therapeutic tool for critically ill patients presenting with hyperthermia and autonomic instability suspicious for serotonin syndrome.
May support cyproheptadine trial in suspected serotonin syndrome; hypothesis-generating and requires prospective confirmation before practice change.
Serotonin syndrome is a life-threatening syndrome that can occur when medications or drugs that cause serotonergic activity are taken. Frequently this syndrome is caused using 2 serotonergic medications at once or switching from 1 serotonergic medication to another without tapering appropriately. The classic triad of serotonin syndrome is neuromuscular excitability, autonomic dysfunction, and altered mental status. Patients can have symptoms ranging from tachycardia, diaphoresis, fever, and hypertension to severe swings in blood pressure, tremors, hyperreflexia, muscle rigidity, and even death. Most patients admitted to the hospital with fevers, tachycardia with hypertension, or hypotension will have blood cultures drawn as infection can easily explain these symptoms. If these symptoms persist, however, other options should be explored, including serotonin syndrome.
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Miller et al. (2023) conducted a case report in Serotonin Syndrome (n=1). Cyproheptadine was evaluated on Resolution of symptoms (hyperthermia, tachycardia). Administration of cyproheptadine successfully resolved severe hyperthermia, tachycardia, and diarrhea in a critically ill patient suffering from serotonin syndrome.
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