The Role of Dexmedetomidine in Treating Serotonin Syndrome

the MPR take:

Because there are no confirmatory lab tests for serotonin syndrome, diagnosis may be challenging and treatment can be complex. Three symptoms that are generally present in a patient with serotonin syndrome include acute altered mental status, neuromuscular abnormalities, and autonomic instability following the use of a serotonergic drug.  In an article published in the Annals of Pharmacotherapy, three cases of refractory serotonin syndrome in adolescents are presented. In all three of these cases, despite the use of high doses of midazolam and/or propofol, symptoms continued to persist; however, upon administration of the alpha-2 adrenergic agonist dexmedetomidine improvement in clinical symptoms was noted.  While not studied in humans, animal models have shown that alpha-2 stimulation can stabilize serotonin neurotoxicity. No serious side effects with dexmedetomidine were seen in these cases. Because respiratory function is minimally suppressed, dexmedetomidine has an advantage over other sedating agents. The authors conclude that dexmedetomidine may be considered an adjunctive therapy when dealing with severe serotonin syndrome refractory to standard therapy, but given the limited data more research needs to be done.

The Role of Dexmedetomidine in Treating Serotonin Syndrome
The Role of Dexmedetomidine in Treating Serotonin Syndrome

Objective: Patients suffering from moderate to severe serotonin syndrome frequently present with autonomic instability and altered mental status. Management of serotonin syndrome can be complex and may be refractory to treatment with benzodiazepines alone. The objective of this series is to present 3 cases of serotonin syndrome that demonstrated clinical improvement with initiation of dexmedetomidine.

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