14th February 2025

Management of SS

The most important step is to stop the serotonergic drug trigger. In mild cases of SS, dose reduction is another option, and none of the below may be required.

Supportive care includes rehydration and cooling. The latter requires physical measures as antipyretics are ineffective; invasive measures for severe hyperthermia include cold fluid gastric lavage and intravascular cooling.

Pharmacological treatment may include:

• Sedation (one of the following options, from low to high SS severity): cyproheptadine (antihistamine), benzodiazepine ± morphine, propofol
• Activated charcoal: if overdose taken in preceding 1 hour
• Chlorpromazine: first-generation antipsychotic with serotonin antagonist properties (limited evidence)

Escalation to ICU may be required in severe SS for airway management and sedation.