Which of the following statements regarding the management of serotonin syndrome is correct?

A. External cooling is never indicated in the management of patients with serotonin syndrome.
B. Efforts to lower hyperthermia are not compromised by the presence of muscle rigidity.
C. Core body temperature can be accurately assessed using a tympanic thermometer.
D. Benzodiazepines are considered the first drug of choice to treat muscle rigidity.
E. Attempts at serotonin receptor blockade with cyproheptadine may be appropriate for all patients.
 
 

• Answer D is correct.

• Benzodiazepines are considered the first drug of choice to treat muscle rigidity.
• Dantrolene has also been used to treat muscle rigidity; however, some authors have suggested that it can have significant adverse effects.

• External cooling, in addition to discontinuation of the offending agent(s), is an important early step in the management of severe cases.

• Efforts to lower hyperthermia become more successful once muscular rigidity resolves.

• Core body temperature is only reliably measured by using rectal or arterial devices.

• External cooling is most efficiently accomplished by using a combination of techniques.

• Blockade of serotonin receptors should be reserved for patients with persistent or severe symptoms.

• Myoclonus and other symptoms have been successfully treated with cyproheptadine.
• Methysergide has also been reported to be effective.

• Additionally, patients who have recovered from serotonin syndrome may be at higher risk for recurrence upon drug rechallenge.  In addition to close monitoring, consider discontinuing combination drug therapy, decreasing drug dosages, or using lower potency serotonergic agents.

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