Bromocriptine neuroleptic malignant syndrom

Neuroleptic malignant syndrome is an acute iatrogenic condition caused by neuroleptics, characterized by tremor, catatonia, fluctuating consciousness, hyperthermia, and cardiovascular instability. It is relatively uncommon, occuring in 1-1.5% of patients but is fatal in 11-38%, most often due to cardiovascular collapse (Jahan et al. 1992). The pathogenesis of neuroleptic malignant syndrome is poorly understood, but it is believed to result from altered dopamine and serotonin transmission in the hypothalamus, spinal cord, and striatum. Treatment includes discontinuation of neuroleptics and administration of drugs that increase dopamine transmission bromocriptine or L-dopa (Jahan etal. 1992 Baldessarini 1996). 

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

Mueller PS, Vester JW, Fermaglich J. Neuroleptic malignant syndrome. Successful treatment with bromocriptine. JAMA 1983 249(3) 386-8. 

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. 

The treatment of neuroleptic malignant syndrome consists of inunediately discontinuing the neuroleptic agent and administering dantrolene sodium and dopamine-functionenhancing substances such as levodopa-carbidopa, bromocriptine, or amantadine. 

Temperature regulation problems (neuroleptic malignant syndrome [NMS], treated with dantrolene and bromocriptine)... 

Additive dopaminergic effects would be expected. The serotonin syndrome is thought to occur because of increased stimulation of the 5-HT receptors in the brainstem and spinal cord. A syndrome resembling neuroleptic malignant syndrome (which has similar symptoms to the serotonin syndrome) can occur when a dopamine agonist like bromocriptine is... 

A 15-year-old male titrated to 20 mg daily of aripiprazole over a 4-week period developed neuroleptic malignant syndrome which was successfully treated with bromocriptine he also showed signs on MRI of posterior reversible encephalopathy syndrome which can be associated with neuroleptic malignant syndrome. 

---