ToxicologyEmergencyPsychiatry
Serotonin syndrome
Recognition (Hunter criteria) and management of serotonin syndrome from SSRI/SNRI/MAOI/triptan/linezolid combinations.
Source: Hunter criteria (Dunkley 2003); TOXBASE/NPIS; BNF
Step 1 of ~6
action
Identify serotonergic combination
Common combinations triggering serotonin syndrome:
• SSRI + MAOI / linezolid / methylene blue
• SSRI + tramadol / pethidine / fentanyl
• SSRI + triptans, lithium
• Recent switch SSRI ↔ SSRI without washout
• Drugs of abuse: MDMA, cocaine, LSD
ABCDE; continuous monitoring; bloods: VBG, U&E, CK (rhabdomyolysis), LFTs, INR, glucose, paracetamol/salicylate.
Key ddx: NMS (recent neuroleptic, lead-pipe rigidity, hyporeflexia), anticholinergic toxidrome (dry, NO clonus), thyroid storm, sympathomimetic toxidrome, malignant hyperthermia.
Related
Curated clinical cross-links plus same-class fallbacks.
Drugs
- CyproheptadineRecommendedAntidote / Antihistamine
- LorazepamRecommendedBenzodiazepine
- MidazolamRecommendedBenzodiazepine
Same class
Pathways
- Paracetamol overdose · TOXBASE/NPIS; MHRA DSU 2012/2024; SNAP regimen (Lancet 2014); BNF
- TCA overdose · TOXBASE/NPIS; AACT/EAPCCT position statements; Resuscitation Council UK ALS
- Opioid overdose · TOXBASE/NPIS; Resuscitation Council UK; BNF
- Anticholinergic toxidrome · TOXBASE/NPIS; AACT/EAPCCT; BNF
- Benzodiazepine overdose · TOXBASE/NPIS; AACT/EAPCCT; BNF
- β-blocker overdose · TOXBASE/NPIS; AACT/EAPCCT; ESC; BNF
Decision support only. Always apply local guidelines and clinical judgement.