Treatment of Refractory Serotonin Syndrome with Dexmedetomidine

Francis D’Orazi, Mohamed M Mansour

Department of Medicine, Division of Pulmonary and Critical Care, Stony Brook University Hospital, HSC 17-027, 101 Nicolls Rd, Stony Brook, NY 11794, USA


Objectives: Dexmedetomidine, a centrally acting alpha-2- adrenergic agonist that inhibits norepinephrine and serotonin release, has gained popularity for its use for certain types of delirium and withdrawal.  Herein, we describe a novel case of Dexmedetomidine use in the treatment of an adult patient with delirium due to serotonin syndrome. Methods: After unsuccessful treatment with Benzodiazepines, and Cyproheptadine, a patient was transferred to our institution with “refractory” serotonin syndrome.  Upon arrival, the patient was confused, tremulous and minimally responsive to verbal stimuli, with unstable vital signs, and was started on a Dexmedetomidine infusion. Results: Within two hours of initiation, the patient’s vital signs stabilized.  Within 12 hours, mental status improved to baseline. Conclusions: Management of Serotonin syndrome is based on cessation of the offending agent and supportive care. Dexmedetomidine has been shown to inhibit serotonin release in animal models. This case describes its successful adjunctive use in difficult to treat Serotonin syndrome. Journal of Nature and Science, 1(2):e47, 2015.

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