Antipsychotics neuroleptic malignant

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. 

Neuroleptic malignant syndrome is a rare condition which can occur even after the single administration of antipsychotics. It manifests itself with hyperpyrexia, muscle rigidity, autonomic symptoms, clouding of consciousness and it has a mortality rate of over 10%. The aetiology is unknown but dopamine blockade may play a role. 

Neuroleptic Malignant Syndrome with Atypical Antipsychotics... 

Caroff SN, Mann SC, Campbell EC. Atypical antipsychotics and neuroleptic malignant syndrome. Psychiatr Ann 2000 30 314-321. 

Lack of antipsychotics more serious complications, such as tardive dyskinesia, neuroleptic malignant syndrome, other extrapyramidal reactions, or significant hypotension... 

Immediate discontinuation of the antipsychotic and the use of bromocriptine when needed to manage symptoms if a neuroleptic malignant syndrome develops... 

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. 

Neuroleptic malignant syndrome D2-blocking antipsychotics Acute severe parkinsonism hypertension, hyperthermia, normal or reduced bowel sounds, onset over 1-3 days Diphenhydramine (parenteral), cooling if temperature is very high, sedation with benzodiazepines... 

Neuroleptic Malignant Syndrome. Patients taking relatively high doses of the more potent antipsychotics may experience a serious disorder known as neuroleptic malignant syndrome (NMS).48 Symptoms of NMS... 

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. 

Mujica R, Weiden P. Neuroleptic malignant syndrome after addition of haloperidol to atypical antipsychotic. Am J Psychiatry 2001 158(4) 650-1. 

Hasan S, Buckley P. Novel antipsychotics and the neuroleptic malignant syndrome a review and critique. Am J Psychiatry 1998 155(8) 1113-6. 

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... 

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