Treatment in serotonin Syndrome

 Q: All of the following should be avoided as a treatment in serotonin syndrome EXCEPT? (select one) 

A) Chlorpromazine 

B) Benzodiazepine 

C) Propranolol 

D) Bromocriptine 

E) Dantrolene

Answer: B

Except for sedation (benzodiazepine), discontinuation of an offending drug, and supportive treatment, none of the treatments has shown any benefit in serotonin syndrome. Although cyproheptadine is widely used, it has a very weak evidence of direct benefit. Due to its low-risk, it is ok to use as benefit outweighs the risk.

Chlorpromazine can worsen hyperthermia of serotonin syndrome (choice A).

Propranolol with its long duration of action may mask tachycardia and misguide clinicians (choice C). 

Bromocriptine is also found to make serotonin syndrome worse (choice D). 

Dantrolene is the treatment for malignant hyperthermia and has no role in serotonin syndrome (choice E).

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References:

1. Boyer EW, Shannon M. The serotonin syndrome. N Engl J Med 2005; 352:1112. 

2. Nisijima K, Shioda K, Yoshino T, et al. Diazepam and chlormethiazole attenuate the development of hyperthermia in an animal model of the serotonin syndrome. Neurochem Int 2003; 43:155. 

3. Graudins A, Stearman A, Chan B. Treatment of the serotonin syndrome with cyproheptadine. J Emerg Med 1998; 16:615.