Ineffective Rx in SS

Q: All of the following should be avoided in Serotonin syndrome (SS) EXCEPT?

A) Propranolol

B) Bromocriptine

C) Dantrolene

D) Lorazepam

Answer: D

In the past, propranolol, bromocriptine, or dantrolene have been suggested in the treatment of SS but were found ineffective or may even harm the patient.

Propranolol has a long duration of action and causes prolonged hypotension. Moreover, it can deceive clinicians by masking tachycardia, which is one of the cardinal signs used to monitor improvement via recommended modalities.

Bromocriptine, being a serotonin agonist, is thought to help in SS but has been found to worsen serotonin syndrome.

Hyperthermia in SS is usually not due to skeletal muscle hyperactivity, and though dantrolene has been used in the past, it has either been ineffective or has no role.

Sedation with "benzos" is recommended in SS.

#neurology

#toxicity

#pharmacology

References:

1. Chiew AL, Isbister GK. Management of serotonin syndrome (toxicity). Br J Clin Pharmacol. 2025 Mar;91(3):654-661. French. doi: 10.1111/bcp.16152. Epub 2024 Jun 26. PMID: 38926083; PMCID: PMC11862804.

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.