Table 3. Drugs used in the management of SS and their doses.

SS, serotonin syndrome

Drug class
Sedatives and anticonvulsants	Lorazepam - 2-4 mg intravenously diazepam - 5-10 mg intravenously depending upon the patient response, the doses can be repeated every 8 -10 min.
Antihypertensives	Esmolol - loading dose of 0.25-0.5 mg/kg IV over 1 min followed by a maintenance dose of 0.05 mg/kg/min for 4 min. Dose can be increased every 10 min by 0.025-0.05 mg/kg/min up to a maximum of 0.2 mg/kg/min. Sodium nitroprusside - 0.25 mcg/kg/min IV infusion. The dose can be titrated every 5 min by 0.25 mcg/kg/min up to a maximum dose of 8 mcg/kg/min.
Serotonin antagonists	Cyproheptadine - per oral - initial dose of 12 mg followed by 2 mg every 2 h if the symptoms persist. If the patient is stabilized, a maintenance dose of 8 mg every 6 h should be given. Chlorpromazine - 50-100 mg intramuscularly. Not recommended in cases of hypotension, as it can precipitate shock. It can also increase hyperthermia.
Neuromuscular blocking agents	Rocuronium - 0.01-0.012 mg/kg/min IV vecuronium - 0.01-mg/kg IV to be given 20-45 min after rapid sequence intubation, every 12-15 min as needed to maintain paralysis.