Antipsychotic drugs neuroleptic malignant syndrome

Other sedative-hypnotic medications, such as barbiturates, may play a useful role in severe withdrawal from this group of drugs. For example, in a case series of GBL withdrawal, use of intravenous pentobarbital in the range of 1-2 mg/kg/hour lowered the total requirement for intravenous lorazepam (Sivilotti et al. 2001). Antipsychotic medications are often used to reduce psychotic agitation. However, because antipsychotic medications lower the seizure threshold and may contribute to loss of central control of temperature leading to hyperthermia or neuroleptic malignant syndrome (NMS), they are not indicated as first-line medications for GHB withdrawal delirium (Dyer and Roth 2001 McDaniel and Miotto 2001 Sharma et al. 2001). If anti-... 

Neuroleptic malignant syndrome (NMS) A potentially fatal symptom complex sometimes referred to as NMS has been reported in association with promethazine alone or in combination with antipsychotic drugs. Clinical manifestations of NMS are hyperpyrexia, muscle rigidity, altered mental status, and evidence of autonomic instability (eg, irregular pulse or blood pressure, tachycardia, diaphoresis, cardiac dysrhythmias). 

Neuroleptic malignant syndrome (NMS) NMS is a potentially fatal condition reported in association with antipsychotic drugs and with amoxapine. 

A rare, but potentially fatal idiosyncratic adverse effect is neuroleptic malignant syndrome. This can occur with any antipsychotic drug. The symptoms are rigidity, hyperthermia, autonomic lability, and reduced level of consciousness. Massively elevated levels of creatinine kinase are usually found. Prior to 1984, the mortality rate was around 25% but improved early recognition has considerably reduced this. Management is cessation of antipsychotics, appropriate conservative measures and dantrolene if necessary for muscle rigidity. 

Antipsychotic drugs include the older phenothiazines and butyrophenones, as well as newer atypical drugs. All of these can cause CNS depression, seizures, and hypotension. Some can cause QT prolongation. The potent dopamine D2 blockers are also associated with parkinsonian-like movement disorders (dystonic reactions) and in rare cases with the neuroleptic malignant syndrome, characterized by "lead-pipe" rigidity, hyperthermia, and autonomic instability (see Chapter 29 Antipsychotic Agents Lithium). 

The neuroleptic malignant syndrome, which is classically associated with antipsychotic drugs and is usually attributed to excessive dopamine D2 receptor blockade, can rarely occur with other medications, including tricyclic antidepressants. 

Bobolakis I. Neuroleptic malignant syndrome after antipsychotic drug administration during benzodiazepine withdrawal. J Clin Psychopharmacol 2000 20(2) 281-3. 

Neuroleptic malignant syndrome has been associated with clozapine (SEDA-22, 58) (98), although some doubts were expressed about the features of earlier cases. The presentation can be different from that associated with traditional antipsychotic drugs for example, the patient may not develop rigidity or a rise in creatine kinase activity (SEDA-25, 62). In the light of two cases, a 35-year-old man and a 62-year-old woman, the literature was comprehensively reviewed and the characteristics of neuroleptic malignant syndrome due to clozapine and typical neuroleptic drugs were compared (99). Causation with clozapine... 

All basic and advanced life-support measures should be implemented. Gastric decontamination should be performed. Butyrophenones are readily absorbed by activated charcoal. Aggressive supportive care should be instituted. Dystonic reactions respond well to intravenous benztropine or diphenhydramine. Oral therapy with diphenhydramine or benztropine should be continued for 2 days to prevent recurrence of the dystonic reaction. For patients suffering from neuroleptic malignant syndrome, a potentially fatal condition associated with the administration of antipsychotic drugs, dantrolene sodium, and bromocriptine have been used in conjunction with cooling and other supportive measures. Arrhythmias should be treated with lidocaine or phenytoin. Diazepam is the drug of choice for seizures phenytoin is used to prevent recurrence. Hemodialysis and hemoperfu-sion have not been shown to be effective. 

Neuroleptic malignant syndrome - adverse reaction to antipsychotic drugs, hyperthermia, fluctuating loss of consciousness, muscular rigidity and autonomic dysfunction Neuropathy - disease of nerve... 

A variety of neurologic syndromes, involving particularly the extrapyramidal system, occur following short- or long-term use of neuroleptic (antipsychotic) drugs. These include akathisia, dystonia, neuroleptic malignant syndrome, parkinsonism, and tardive dyskinesia. 

Other autonomic effects of antipsychotic drugs are probably mediated by the hypothalamus, such as an impairment of the body s abihty to regulate temperature. Clozapine can induce moderate elevations of body temperature that can be confusing clinically central effects on temperatme regulation and cardiovascular and respiratory function probably contribute to the featmes of neuroleptic malignant syndrome (see Table 18-1). 

The typical antipsychotic drugs (e.g., chlorpromazine, thioridazine, fluphenazine, and haloperidol) act primarily as DA antagonists, blocking Dj receptors. Side effects include the induction of pseudo-Parkinsonism, akathisia, and/or acute dystonic effects. Their use and symptom management are discussed, as are other adverse effects including toxicity, tardive dyskinesia, and neuroleptic malignant syndrome. 

Neuroleptic malignant syndrome (NMS) continues to be an unpredictable and rare - but potentially fatal - complication associated with the use of antipsychotic drugs (APDs)J ... 

Garcia G, Ghani S, Poveda RA, Dansky BL Neuroleptic malignant syndrome with antide-pressant/antipsychotic drug combination. Ann Pharmacother(200 )35, 784-5. 

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