Nguyen Hien, Pan Angel, Smollin Craig, Cantrell Lee F, Kearney Tom
School of Pharmacy, University of California San Francisco, San Francisco, California.
Alta Bates Summit Medical Center, Oakland, California.
J Clin Pharm Ther. 2019 Apr;44(2):327-334. doi: 10.1111/jcpt.12796. Epub 2019 Jan 16.
Cyproheptadine is a serotonin and histamine antagonist that has been suggested as a treatment for serotonin syndrome in case reports.
We sought to examine the differences between outcomes and treatment recommendations in patients who received and did not receive cyproheptadine for a probable serotonin syndrome.
A retrospective review of cases reported to the California Poison Control System between 2006 and 2017 involving cyproheptadine administration or consideration for treatment of a probable serotonin syndrome.
A total of 1420 cases were identified and 288 cases met the inclusion criteria. Of these, 68 (23.1%) patients received cyproheptadine treatment and were significantly older (mean age 49.7 vs 33.5 years, P < 0.00001), intubated (n = 35, 51% vs n = 62, 28%, P < 0.05) and, although not statistically significant, were more frequently admitted to a critical care unit (n = 56, 82.3% vs n = 154, 70.0%, P = 0.09). There were no significant differences in serious outcomes (moderate or worse effects) or hospitalization rates (OR, 1.09, 95% CI, 0.49-2.64 and OR, 1.99, 95% CI, 0.86-4.58). There were eight fatalities, of which two patients received cyproheptadine. All fatalities were acute polypharmacy ingestions and had manifested severe symptoms (seizures, hypotension or hyperthermia) either prior to the administration or consideration of cyproheptadine therapy. Cyproheptadine was not administered in 138 (48%) cases primarily due to minimal clinical severity and patient improvement (43%), and not recommended in 82 (28%) cases for reasons from waiting for response to other supportive measures (30%), limited evidence of efficacy (28%) and undetermined diagnosis (14.6%).
The benefits of and indications for cyproheptadine are uncertain and questionable for the management of a serotonin syndrome. Future recommendations on its use should be based on diagnostic criteria, severity of symptoms and management in conjunction with other supportive measures.
赛庚啶是一种血清素和组胺拮抗剂，在病例报告中曾被建议用于治疗血清素综合征。
我们试图研究接受和未接受赛庚啶治疗的疑似血清素综合征患者在治疗结果和治疗建议上的差异。
对2006年至2017年期间向加利福尼亚中毒控制系统报告的涉及赛庚啶给药或考虑用于治疗疑似血清素综合征的病例进行回顾性分析。
共识别出1420例病例，其中288例符合纳入标准。在这些病例中，68例（23.1%）患者接受了赛庚啶治疗，他们年龄显著更大（平均年龄49.7岁对33.5岁，P < 0.00001），需要插管（n = 35，51%对n = 62，28%，P < 0.05），并且尽管无统计学意义，但更频繁地被收入重症监护病房（n = 56，82.3%对n = 154，70.0%，P = 0.09）。在严重后果（中度或更严重影响）或住院率方面无显著差异（比值比，1.09，95%置信区间，0.49 - 2.64；比值比，1.99，95%置信区间，0.86 - 4.58）。有8例死亡病例，其中2例患者接受了赛庚啶治疗。所有死亡病例均为急性多药摄入，并且在给予或考虑赛庚啶治疗之前就已出现严重症状（癫痫发作、低血压或高热）。138例（48%）病例未给予赛庚啶，主要原因是临床严重程度轻微且患者病情改善（43%），82例（28%）病例未推荐使用赛庚啶，原因包括等待其他支持措施的反应（30%）、疗效证据有限（28%）以及诊断未明确（14.6%）。
赛庚啶在血清素综合征管理中的益处和适应证尚不确定且存在疑问。未来关于其使用的建议应基于诊断标准、症状严重程度以及与其他支持措施相结合的管理方法。
