Cyproheptadine for Serotonin Toxicity: an Updated Systematic Review and Grading of Evidence

AbstractPurpose of ReviewSerotonin toxicity (ST) is a serious clinical entity caused by drug-induced serotonin excess in the central nervous system. Animal studies and some human data indicate that activation of specific serotonin receptor subtypes, namely 5-HT1A and 5-HT2A, are involved in ST pathophysiology, suggesting that serotonin antagonists could be used to treat ST. However, to date, high-quality evidence for the clinical utility of the most commonly employed serotonin antagonist, cyproheptadine, is lacking. This systematic review provides a clinical update on the evidence regarding use cyproheptadine for treating ST and compiles cyproheptadine treatment recommendations from recent review articles.Recent FindingsPublished articles concerning the use of cyproheptadine for treating ST are exclusively case reports and case series (n = 151); most provide very low-quality evidence (i.e., grade D,n = 148) and the remaining few provide low-quality evidence (i.e., grade C,n = 3). Most recent review articles (n = 18) acknowledge this low level of evidence and propose cyproheptadine as an optional treatment, whereas others recommend its use in the clinical setting.SummaryAlthough ST has been recognized as a clinical entity for decades, rigorous trials demonstrating the therapeutic efficacy of cyproheptadine are lacking, warranting large-scale prospective human trials of antiserotonergic agents using a coordinated multicenter approach.
Source: Current Emergency and Hospital Medicine Reports - Category: Emergency Medicine Source Type: research