Cyproheptadine and the treatment of an unconscious patient with the serotonin syndrome

Baigel, G.

doi:10.1097/00003643-200307000-00017

Cited by 14 publications

(6 citation statements)

References 7 publications

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“…Thus, physicians faced with the diagnostic dilemma of SS vs. NMS can confidently institute the above measures. Although no clinical trials have yet demonstrated its efficacy, cyproheptadine is a 5-HT 2A receptor antagonist with theoretical benefit in serotonin syndrome that has been reported to successfully treat SS in multiple case reports (5,6).…”

Section: Discussionmentioning

confidence: 99%

Antibiotic-Induced Serotonin Syndrome

Miller

Lovell

2011

The Journal of Emergency Medicine

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Section: Discussionmentioning

confidence: 99%

Antibiotic-Induced Serotonin Syndrome

Miller

Lovell

2011

The Journal of Emergency Medicine

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“…2,9 Cyproheptadine has been shown to be helpful in a select number of cases. 8,9 It is an antihistamine with anticholinergic and antisertonergic properties that has shown to prevent SS in animals but has yet to be rigorously tested in humans. 9 In our patient, the judicious use of cyproheptadine led to a complete and quick resolution of the SS.…”

Section: Discussionmentioning

confidence: 99%

Rare Case of Serotonin Syndrome With Therapeutic Doses of Paroxetine

Paruchuri

Godkar²,

Anandacoomarswamy

et al. 2006

American Journal of Therapeutics

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Paroxetine (Paxil) is a selective serotonin reuptake inhibitor (SSRI) and anxiolytic that is approved to treat numerous mood disorders. Serotonin syndrome, defined as a triad of mental status changes, autonomic instability, and neuromuscular abnormalities, is a potentially life-threatening complication of administering such serotonin-modifying drugs. Most cases of serotonin syndrome that have occurred with paroxetine administration are due to inadvertent drug interactions, most notably between SSRIs and monamine oxidase inhibitors, or intentional overdoses. The authors present the case of an 80-year-old woman who presented with serotonin syndrome while on a therapeutic dose of paroxetine. Paroxetine was stopped, and aggressive hydration with fluids and treatment with cyproheptadine was followed by remarkable improvement and return to baseline status in 4 days. This case illustrates the importance for physicians to have a heightened sense of suspicion of the serotonin syndrome in any patient known to be on serotonin-modifying agents presenting with altered sensorium and cholinergic symptoms. Consequently, they will be able to start timely treatment without subjecting the patient to unnecessary and potentially harmful tests.

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“…106 There is some evidence from case reports that support its role in reducing symptoms in mild to moderate SS, though there its role in severe SS is less clear. 111-115 Cyproheptadine is a histamine-1 receptor antagonist with nonspecific 5-HT 1A , 5-HT 2A , 5-HT 2B , 5-HT 2C , 5-HT 3 , 5-HT 6 , and 5-HT 7 receptor antagonistic properties as well as some weak anticholinergic effects. 111 The purported role of 5-HT 2A antagonism in mediating cyproheptadine’s beneficial effect is interesting, given that there appears to be an association between 5-HT 2A antagonists themselves in the form of SGAs and the risk of SS.…”

Section: Managementmentioning

confidence: 99%

Serotonin Syndrome: Pathophysiology, Clinical Features, Management, and Potential Future Directions

Scotton

Hill

Williams

et al. 2019

Int J�Tryptophan�Res

157

161

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Serotonin syndrome (SS) (also referred to as serotonin toxicity) is a potentially life-threatening drug-induced toxidrome associated with increased serotonergic activity in both the peripheral (PNS) and central nervous systems (CNS). It is characterised by a dose-relevant spectrum of clinical findings related to the level of free serotonin (5-hydroxytryptamine [5-HT]), or 5-HT receptor activation (predominantly the 5-HT1Aand 5-HT2Asubtypes), which include neuromuscular abnormalities, autonomic hyperactivity, and mental state changes. Severe SS is only usually precipitated by the simultaneous initiation of 2 or more serotonergic drugs, but the syndrome can also occur after the initiation of a single serotonergic drug in a susceptible individual, the addition of a second or third agent to long-standing doses of a maintenance serotonergic drug, or after an overdose. The combination of a monoamine oxidase inhibitor (MAOI), in particular MAO-A inhibitors that preferentially inhibit the metabolism of 5-HT, with serotonergic drugs is especially dangerous, and may lead to the most severe form of the syndrome, and occasionally death. This review describes our current understanding of the pathophysiology, clinical presentation and management of SS, and summarises some of the drugs and interactions that may precipitate the condition. We also discuss the newer novel psychoactive substances (NPSs), a growing public health concern due to their increased availability and use, and their potential risk to evoke the syndrome. Finally, we discuss whether the inhibition of tryptophan hydroxylase (TPH), in particular the neuronal isoform (TPH2), may provide an opportunity to pharmacologically target central 5-HT synthesis, and so develop new treatments for severe, life-threatening SS.

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Cyproheptadine and the treatment of an unconscious patient with the serotonin syndrome

Cited by 14 publications

References 7 publications

Antibiotic-Induced Serotonin Syndrome

Antibiotic-Induced Serotonin Syndrome

Rare Case of Serotonin Syndrome With Therapeutic Doses of Paroxetine

Serotonin Syndrome: Pathophysiology, Clinical Features, Management, and Potential Future Directions

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