open access publication

Review, 2023

Serotonin syndrome-A focused review

In: BASIC & CLINICAL PHARMACOLOGY & TOXICOLOGY, ISSN 1742-7835, 1742-7835, Volume 133, 2, Pages 124-129, 10.1111/bcpt.13912

Contributors (3)

Mikkelsen, Nicolaj (Corresponding author) [1] [2] Damkier, P. (0000-0003-0591-7187) [1] [2] Pedersen, Sidsel Arnspang [1] [2]


  1. [1] Odense Univ Hosp, Dept Clin Pharmacol, Odense, Denmark
  2. [NORA names: Region of Southern Denmark; Hospital; Denmark; Europe, EU; Nordic; OECD]
  3. [2] Odense Univ Hosp, Dept Clin Pharmacol, Odense, Denmark
  4. [NORA names: SDU University of Southern Denmark; University; Denmark; Europe, EU; Nordic; OECD]


BackgroundSerotonin syndrome is a potentially life-threatening syndrome with manifestations spanning from mild adverse effects to life-threatening toxicity. The syndrome is caused by overstimulation of serotonin receptors by serotonergic drugs. Since the use of serotonergic drugs is increasing, primarily due to the widespread use of selective serotonin reuptake inhibitors, cases of serotonin syndrome have likely seen a parallel increase. The true incidence of serotonin syndrome remains unknown due to its diffuse clinical presentation. ObjectivesThis review aims to provide a clinically focused overview of serotonin syndrome, covering its pathophysiology, epidemiology, clinical manifestations, diagnostic criteria, differential diagnosis and treatment, as well as classifying serotonergic drugs and their mechanism of action. The pharmacological context is emphasized, as it is crucial for the detection and management of serotonin syndrome. MethodsFocused review based on a literature search using the PubMed database. Findings and conclusionSerotonin syndrome can occur through therapeutic use or overdose of a single serotonergic drug or as a drug interaction between two or more serotonergic drugs. Central clinical features consist of neuromuscular excitation, autonomic dysfunction and altered mental status, occurring in a patient undergoing new or altered serotonergic therapy. Early clinical recognition and treatment are crucial to prevent significant morbidity.


5-hydroxytryptophan, Hunter Serotonin Toxicity Criteria, serotonergic drugs, serotonin syndrome, serotonin toxicity