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Due to the implementation of stricter regulations in many countries, carisoprodol toxicity is an increasingly uncommon presentation to the emergency department. However, it remains a potential drug of abuse due to its low price, availability and ability to modulate GABA-A. Others have reported presentations that challenge the GABAergic mechanism of carisoprodol. Here, we present a case of serotonin syndrome with carisoprodol holding a pivotal role. This case highlights the potential serotonergic activity of carisoprodol which contradicts the agent’s supposed GABAergic mechanism of action.