Serotonin Syndrome management

McDaniel WW Serotonin syndrome early management with cyproheptadine. Ann Pharma-cother 200i 35 870-873. 

Sporer KA. The serotonin syndrome. Implicated drugs, pathophysiology and management. Drug Saf 1995 13(2) 94—104. 

Treatment of an overdose of the atypical antidepressants and SSRIs is directed primarily toward decontamination of the gastrointestinal tract with activated charcoal, symptomatic treatment, and general supportive care. Management of the serotonin syndrome involves discontinuation of the serotinergic agent and supportive therapy. Beu-zodiazepines, propranolol, and cyproheptadine, a serotonin antagonist, have been used successfully. ... 

For the management of serotonin syndrome, see Importance and management under MAOIs or RIMAs + Tricyclic and related antidepressants , p.ll49. 

For a brief mention of the treatment of hypertensive crisis, see Importance and Management under MAOIs or RIMAs + Sympathomimetics Indirectly-acting , p.ll47. For the management of fever and other symptoms of the serotonin syndrome, see Importance and management under MAOIs or RIMAs + Tricyclic and related antidepressants , p.ll49. 

Two cases of serotonin syndrome were attributed to adding ritonavir to established fluoxetine treatment. In one patient this was managed by halving the fluoxetine dose, and in the other ritonavir was withdrawn. Other cases of the serotonin syndrome have been seen in patients taking ritonavir or indinavir with fluoxetine. One involved the additional use of trazodone , (p.l229), and the other involved large quantities of grapefruit , (p.1217). 

There is no specific antidote to duloxetine, but if serotonin syndrome ensues, specific treatment (such as with cyproheptadine and/or temperature control) may be considered. In a case of acute overdose, treatment should consist of general measures employed in the management of overdose with any drug. 

Redrawn from Gershon MD Serotonin and its implication for the management of irritable bowel syndrome. Rev Gastroenterol Dis 2003 3[Suppl 2] S25.)... 

Other clinical uses Tricyclic drugs are also used in the treatment of bipolar affective disorders, acute panic attacks, phobic disorders (compare with alprazolam Chapter 22), enuresis, and chronic pain states. Clomipramine and the selective serotonin reuptake inhibitors, including fiuvoxamine, are effective in obsessive-compulsive disorders. SSRls are also effective in patients who suffer from panic attacks, social phobias, bulimia, and premenstrual syndrome (PMS) and may also be useful in the treatment of alcohol dependence. Bupropion is used for management of patients attempting to withdraw from nicotine dependence. 

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