Serotonin Syndrome

Jason Chao, MD, Darrell Hulisz, RPh, PharmD and Eric Yeh, MD Reviewed 06/2018

BASICS

DESCRIPTION

A potentially life-threatening adverse drug reaction that results from excessive stimulation of peripheral and CNS serotonergic receptors
It is a concentration-dependent toxicity that...

DIAGNOSIS

Serotonin syndrome is a clinical diagnosis.
Hunter Toxicity Criteria Decision Rules aid in the diagnosis of clinically significant serotonin toxicity (sensitivity, 84%; specificity, 97%). A p...

TREATMENT

Discontinue all serotonergic agents.
Supportive care is the mainstay of therapy. This includes administration of oxygen and aggressive IV fluids, continuous cardiac monitoring, and correction...

ONGOING CARE

FOLLOW UP RECOMMENDATIONS

In mild cases of serotonin toxicity, address risks and benefits of restarting offending agents. Serotonergic medications need to be titrated slowly, and patients ...

REFERENCES

Bronstein AC, Spyker DA, Cantilena LRJr, et al. 2008 Annual report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 26th annual report. Clin Toxic...

ADDITIONAL READING

Isbister GK, Buckley NA, Whyte IM. Serotonin toxicity: a practical approach to diagnosis and treatment. Med J Aust. 2007;187(6):361–365. [View Abstract on OvidMedline]
McAllen...

CODES

ICD10

G25.79 Other drug induced movement disorders

ICD9

333.99 Other extrapyramidal diseases and abnormal movement disorders

SNOMED

371089000 Serotonin syndrome (disorder)

CLINICAL PEARLS

Consider serotonin syndrome in patients with recent use of a serotonergic agent (particularly if multiple proserotonergic agents are involved) presenting with unexplained tachycardia, ...

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