Neurocritical Care
Intravenous immunoglobulin 0.4 g/kg/day Γ 3β5 days or plasmapheresis 20β25 mL/kg plasma Γ 5
exchanges every other day Γ 10 days
Similarly effective; can choose according to patient risk factors, etc.
taper)
Supportive Care β Consider discontinuing cholinergic therapies while the patient is acutely ill. May
increase pulmonary secretions and complicate ventilator/ICU management
Autonomic hyperactivity (hypertension, tachycardia)
Hyperthermia β Diaphoresis
Seizures
Neuromuscular abnormalities
Rigidity
Hyperreflexia and clonus
Shivering
Diarrhea
caused by a single therapeutic agent, a combination of agents, or overdose. Common serotonergic drugs
are listed in Table 15.
features are listed in Table 16.
Drug Class
Associated Drugs
Antiemetics
Ondansetron, granisetron, metoclopramide
Antiepileptics
Lamotrigine, carbamazepine, valproic acid
Anti-migraine
Triptans, ergotamine, methylergonovine
Herbal products
St. Johnβs wort, tryptophan, ginseng
Illicit drugs
Methamphetamine, amphetamine, ecstasy (MDMA), psilocybin, LSD
Opioids
Fentanyl, meperidine, methadone, dextromethorphan, tramadola
SSRIs
Citalopram,a fluoxetine,a sertraline,a escitalopram, paroxetine
SNRIs
Venlafaxine, duloxetine
TCAs
Amitriptyline, clomipramine, imipramine
MAOIs
Phenelzine, rasagiline, selegiline
Others
Bupropion,a buspirone, lithium, trazodone
Miscellaneous
Linezolid, cyclobenzaprine, methylene blue, fluconazole,
chlorpheniramine
aTop 5 agents implicated in serotonin syndrome
MAOIs = monoamine oxidase inhibitors; SNRIs: serotonin and norepinephrine reuptake inhibitors; SSRIs: selective serotonin reuptake inhibitors; TCAs: tricyclic
antidepressants.
Information from: Mikkelsen N, Damkier P, Arnspang Pedersen S. Serotonin syndrome β a focused review. Basic Clin Pharmacol Toxicol 2023;133:124-9; Pedavally S,
Fugate JE, Rabinstein AA. Serotonin syndrome in the intensive care unit: clinical presentations and precipitating medications. Neurocrit Care. 2014;21:108-13.