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Ott M, Mannchen JK, Jamshidi F, et al. Management of severe arterial hypertension associated with serotonin syndrome: a case report analysis based on systematic review techniques. Ther Adv Psychopharmacol. 2019;9:2045125318818814doi: 10.1177/2045125318818814.
Ott, M., Mannchen, J. K., Jamshidi, F., & Werneke, U. (2019). Management of severe arterial hypertension associated with serotonin syndrome: a case report analysis based on systematic review techniques. Therapeutic advances in psychopharmacology, 92045125318818814. https://doi.org/10.1177/2045125318818814
Ott, Michael, et al. "Management of severe arterial hypertension associated with serotonin syndrome: a case report analysis based on systematic review techniques." Therapeutic advances in psychopharmacology vol. 9 (2019): 2045125318818814. doi: https://doi.org/10.1177/2045125318818814
Ott M, Mannchen JK, Jamshidi F, Werneke U. Management of severe arterial hypertension associated with serotonin syndrome: a case report analysis based on systematic review techniques. Ther Adv Psychopharmacol. 2019 Mar 11;9:2045125318818814. doi: 10.1177/2045125318818814. eCollection 2019. PMID: 30886699; PMCID: PMC6413434.
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Ther Adv Psychopharmacol. 2019 Mar 11;9:2045125318818814. doi: 10.1177/2045125318818814. eCollection 2019.

Management of severe arterial hypertension associated with serotonin syndrome: a case report analysis based on systematic review techniques.

Therapeutic advances in psychopharmacology

Michael Ott, Julie K Mannchen, Fariba Jamshidi, Ursula Werneke

Affiliations

  1. Department of Public Health and Clinical Medicine - Medicine, Umeå University, 901 87 Umeå, Sweden.
  2. Department of Public Health and Clinical Medicine - Family Medicine, Umeå University, Umeå, Sweden.
  3. Sunderby Hospital, Luleå, Sweden.
  4. Sunderby Research Unit, Department of Clinical Sciences - Psychiatry, Umeå University, Umeå, Sweden.

PMID: 30886699 PMCID: PMC6413434 DOI: 10.1177/2045125318818814

Abstract

Serotonin syndrome is thought to arise from serotonin excess. In many cases, symptoms are mild and self-limiting. But serotonin syndrome can become life threatening, when neuromuscular hyperexcitability spins out of control. Uncontainable neuromuscular hyperexcitability may lead to cardiovascular complications, linked to extreme changes in blood pressure. Currently, there is little guidance on how to control blood pressure in hyperserotonergic states. We report a case with treatment-resistant arterial hypertension, followed by a clinical review (using systematic review principles and techniques) of the available evidence from case reports published between 2004 and 2016 to identify measures to control arterial hypertension associated with serotonin syndrome. We conclude that classic antihypertensives may not be effective for the treatment of severe hypertension associated with serotonin syndrome. Benzodiazepines may lower blood pressure. Patients with severe hypertension not responding to benzodiazepines may benefit from cyproheptadine, propofol or both. In severe cases, higher cyproheptadine doses than currently recommended may be necessary.

Keywords: antihypertensive agents; arterial hypertension; cyproheptadine; hypertension; propofol; serotonin antagonists; serotonin syndrome

Conflict of interest statement

Conflict of interest statement: Ursula Werneke has received funding for educational activities (Masterclass Psychiatry Programme/EAPM 2016, Luleå, Sweden): Astra Zeneca, Janssen, Eli Lilly, Lundbeck,

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