Treatment of the serotonin syndrome with cyproheptadine.
Treatment of the serotonin syndrome with cyproheptadine.
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DOI：
10.1016/s0736-4679(98)00057-2
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发表时间：
1998-07-01
期刊：
影响因子：
--
通讯作者：
Chan, B
中科院分区：
文献类型：
--
作者：
Graudins, A;Stearman, A;Chan, B
5-羟色胺综合征是中枢神经5-羟色胺（5 HT）-1a和5 HT-2受体过度刺激的结果。诊断需要有暴露于对5-羟色胺受体有活性的药物的病史，以及精神状态、自主神经不稳定和神经肌肉异常（如震颤、反射亢进或肌阵挛）的改变。在这个描述性病例系列中，报告了5例5-羟色胺综合征病例。所有患者均有近期暴露于一种或多种肾上腺素能药物（包括吗氯贝胺、帕罗西汀、舍曲林和文拉法辛）的病史，并有5-羟色胺综合征的临床证据。所有患者均给予赛庚啶（4-8 mg口服）治疗肾上腺素能体征。3例在给药后2小时内体征完全消退。另外两名患者在首次给药后出现残留震颤或反射亢进，在重复给药后消退。赛庚啶的使用没有不良后果。特异性5-羟色胺受体拮抗剂如赛庚啶在治疗5-羟色胺综合征中的作用仍有待阐明。它的使用应被视为支持性治疗的辅助手段。目前，还不清楚赛庚啶是否会改变患者的预后。
The serotonin syndrome is the result of excess stimulation of central nervous 5-hydroxytryptamine (5HT)-1a and 5HT-2 receptors. The diagnosis requires a history of exposure to agents active at serotonin receptors and the presence of alterations in mental status, autonomic instability, and neuromuscular abnormalities such as tremor, hyperreflexia, or myoclonus. In this descriptive case series, five cases of serotonin syndrome are reported. All patients gave a history of recent exposure to one or more serotonergic medications, including moclobemide, paroxetine, sertraline, and venlafaxine, with clinical evidence of serotonin syndrome. All patients were administered cyproheptadine (4-8 mg orally) for serotonergic signs. Three had complete resolution of signs within 2 h of administration. Another two had a residual tremor or hyperreflexia following the first dose, which resolved following a repeat dose. There were no adverse outcomes from cyproheptadine use. The role of specific serotonin receptor antagonists such as cyproheptadine in the treatment of the serotonin syndrome remains to be delineated. Its use should be considered an adjunct to supportive care. Currently, it is unknown whether cyproheptadine modifies patient outcome.