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This review delves into the pathophysiology, incidence, clinical assessment and management of serotonin toxicity, stressing the significance of promptly recognizing and managing severe cases. Diagnosis relies primarily relies on clinical assessment due to the absence of specific laboratory tests. The Hunter Serotonin Toxicity criteria are commonly utilized but have only been validated in the overdose setting. Assessing the severity of toxicity is crucial for guiding management decisions. Supportive care, discontinuation of causative agents and symptomatic treatment are prioritized in management. Mild toxicity often requires withdrawal or reduction of the serotonergic agent, while more severe toxicity requires more aggressive resuscitative and supportive care. Severe serotonin toxicity characterized by hyperthermia and rigidity requires aggressive supportive measures, including benzodiazepines, intubation, paralysis and active cooling. Animal studies suggest potential benefits of 5\u2010HT2A receptor antagonists in preventing hyperthermia and fatalities, but only at high doses. Their clinical effectiveness remains uncertain, and evidence is predominately from case series and case reports. Although commonly used, serotonin antagonists like cyproheptadine lack conclusive evidence of efficacy. Other serotonin antagonists such as chlorpromazine and olanzapine have been explored but evidence is limited to case reports. Hence, the cornerstone of treating severe cases does not lie in \u2018antidote\u2019 administration or even diagnosis but in effective early resuscitative and supportive care.<\/jats:p>","DOI":"10.1111\/bcp.16152","type":"journal-article","created":{"date-parts":[[2024,6,27]],"date-time":"2024-06-27T01:58:55Z","timestamp":1719453535000},"page":"654-661","source":"Crossref","is-referenced-by-count":30,"title":["Management of serotonin syndrome (toxicity)"],"prefix":"10.1111","volume":"91","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0079-5056","authenticated-orcid":false,"given":"Angela L.","family":"Chiew","sequence":"first","affiliation":[{"name":"Department of Clinical Toxicology Prince of Wales Hospital  Randwick New South Wales Australia"},{"name":"Faculty of Medicine The University of New South Wales  Sydney New South Wales Australia"},{"name":"New South Wales Poisons Information Centre Sydney Children's Hospital  Sydney New South Wales 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