Treatment of the Serotonin Syndrome with Cyproheptadine

Lappin, Richard I.; Auchincloss, Elizabeth L.

doi:10.1056/nejm199410133311514

Cited by 123 publications

(59 citation statements)

References 2 publications

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“…If carisoprodol intoxications are indeed followed by a serotonin syndrome this could point to further possible treatments. These include the use of nonselective 5-HT receptor antagonists methysergide (38) and cyproheptadine (39,40) or the 5-HT 1A specific antagonist propanolol (33,41). The latter also having a desirable effect on the tachycardia that seems to be present.…”

Section: Discussionmentioning

confidence: 99%

Carisoprodol Intoxications and Serotonergic Features

Bramness¹,

Mørland²,

Sørlid³

et al. 2005

LCLT

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CASE REPORTThe symptoms and signs of carisoprodol intoxications do not resemble those caused by its metabolite meprobamate. Meprobamate most probably produces its effects through the GABAergic neurotransmitter system. The signs and symptoms of carisoprodol intoxications, however, are not easily explained by interaction with this neurotransmitter system. In the present study, four cases of carisoprodol intoxications are presented with emphasis on the presence of serotonergic signs and symptoms. All four cases fulfilled three different sets of criteria for the diagnosis of serotonin syndrome. These findings could indicate that an increased serotonin level in the central nervous system could explain some of the symptoms and signs of carisoprodol intoxications. This may have implications for the clinical evaluation and treatment of such intoxications. Since few laboratories routinely screen for carisoprodol it is important to keep this drug in mind when encountering intoxications displaying serotonergic symptoms.

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Section: Discussionmentioning

confidence: 99%

Carisoprodol Intoxications and Serotonergic Features

Bramness¹,

Mørland²,

Sørlid³

et al. 2005

LCLT

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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%

“…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. Its role as a definitive treatment for SS should be further investigated.…”

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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“…Alguns autores usam propanolol 26 ;outros usam a cipro-heptadine, um antagonista serotonínico 24,27 . Green e col. 18 , preconizam o uso de anticonvulsivantes, medicação sedativa (particulamente benzodiazepínicos), baixa da temperatura com gelo, dantrelene sódico.…”

Section: Discussionunclassified

Síndrome serotoninérgica associada ao uso de paroxetina: relato de caso

Cavallazzi

Grezesiuk

1999

Arq. Neuro-Psiquiatr.

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RESUMO-Relatamos um caso de síndrome serotoninérgica pelo uso de inibidor da recaptação da serotonina, a paroxetina. Tal síndrome por esta droga, sem combinações, ainda não tinha sido descrita na literatura.PALAVRAS-CHAVE: síndrome serotoninérgica, paroxetina, mioclonia.Serotonin syndrome associated to the use of paroxetine: case report ABSTRACT-We report on a case of serotonin syndrome associated to the use of the paroxetine, a serotonin reuptake inhibitor drug. Serotonin syndrome related to this drug not combined with other drugs had not yet been described in literature.KEY-WORDS: serotonin syndrome, paroxetine, myoclonus.O uso de antidepressivos do tipo inibidor da recaptação da serotonina tem aumentado nos últimos anos em neurologia e psiquiatria. Como são drogas de introdução recente, pouco se sabe de seus efeitos secundários precoces e tardios. Relatamos um efeito colateral imediato dessas drogas, a síndrome serotoninérgica (ST). RELATO DO CASOMRA, 19 anos, sexo feminino, procurou auxílio médico com sintomas compatíveis com cefaléia tipo tensão episódica e quadro depressivo, com duração de aproximadamente um ano. O exame neurológico era normal. A tomografia computadorizada de crânio, foi normal. Iniciou-se o uso de paroxetina (Aropax) na dose diária de 10 mg , reajustada para 20 mg, 5 dias após o início do tratamento. A partir deste dia, a paciente apresentou quadro abrupto de sudorese fria, hipertemia (38ºC), hipotensão arterial, diaforese, palidez, sensações parestésicas pelo corpo, agitação psicomotora. Este quadro se acompanhava de contrações musculares mioclônicas abruptas e generalizadas nos membros superiores e inferiores, axiais e da face, com predomínio do hemicorpo direito. A paciente permaneceu internada por 48 horas, tendo sido suspensa a paroxetina e iniciado o uso de diazepan, 10 mg diárias, com melhoria das mioclonias generalizadas. Após três dias a paciente foi avaliada por nós e observamos persistência de episódios de mioclonias focais na hemiface direita e por vezes no membro inferior direito, levando-a a cair. A paciente relatava não estar fazendo uso de alimentos contendo triptofano. Os episódios de mioclonias chegavam a durar 10 minutos. Administramos clonazepan (Rivotril), 0, 75 mg por dia, com melhora gradual dos episódios mioclônicos ao longo de 45 dias seguintes. Um eletrencefalograma (EEG) realizado neste período foi normal.Residência de Neurologia do Hospital Governador Celso Ramos, Florianópolis, SC: *Preceptor; **Residente. Aceite: 25-junho-1999.Dr. Luís Otávio Cavallazzi -Rua Barão de Batovi 546 -88015-340 Florianópolis SC -Brasil.

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Treatment of the Serotonin Syndrome with Cyproheptadine

Cited by 123 publications

References 2 publications

Carisoprodol Intoxications and Serotonergic Features

Carisoprodol Intoxications and Serotonergic Features

Rare Case of Serotonin Syndrome With Therapeutic Doses of Paroxetine

Síndrome serotoninérgica associada ao uso de paroxetina: relato de caso

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