In a retrospective study comparing those treated with cyproheptadine and without for serotonin syndrome in California over eleven years, patients who were intubated and sedated were more likely to receive cyproheptadine, but was there a difference in serious outcome or hospitalization?
No. The odds ratio was 1.097 (0.49-2.64) for serious outcome and 1.99 (0.86-4.58) for hospitalization. There was greater hospitalization of patients treated with cyproheptadine than without. This likely reflects clinicians adding cyproheptadine to the treatment regimen of more seriously ill patients, rather than a treatment failure. Because of the retrospective nature of the study, the timing of cyproheptadine in the clinical course is difficult to assess, and therefore its effectiveness at changing outcomes.
Nguyen H, Pan A, Smollin C, Cantrell LF, Kearney T. An 11-year retrospective review of cyproheptadine use in serotonin syndrome cases reported to the California Poison Control System. J Clin Pharm Ther. 2019 Apr;44(2):327-334. doi: 10.1111/jcpt.12796. PMID: 30650197.
Submitted by: VCU Medical Toxicology Fellowship