Title: Neuroleptic Malignant Syndrome<br/>Author: Ellen Lemkin<br/><a href='http://umem.org/profiles/faculty/182/'>[Click to email author]</a><hr/><p dir="ltr" style="text-transform: none; background-color: rgb(255,255,255); text-indent: 0px; font: 13px/1.2272 arial, sans-serif; white-space: normal; margin-bottom: 8pt; letter-spacing: normal; color: rgb(34,34,34); word-spacing: 0px; -webkit-text-stroke-width: 0px">
<span style="font-family: Arial; white-space: pre-wrap; font-size: 13px; vertical-align: baseline">NMS is most often seen with the <u>typical high potency neuroleptic agents </u>(e.g haldol, fluphenazine)</span></p>
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<span style="font-family: Arial; white-space: pre-wrap; font-size: 13px; vertical-align: baseline">All classes of antipsychotics can cause NMS, including low potency and newer atypical agents; antiemetics can cause this as well.</span></p>
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<span style="font-family: Arial; white-space: pre-wrap; font-size: 13px; vertical-align: baseline"><u>Symptoms usually occur after the first 2 weeks of therapy</u>, but may occur after years of use</span></p>
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<span style="font-family: Arial; white-space: pre-wrap; font-size: 13px; vertical-align: baseline">Signs and symptoms include: </span></p>
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<span style="font-family: Arial; white-space: pre-wrap; font-size: 13px; vertical-align: baseline">mental status changes </span></p>
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<span style="font-family: Arial; white-space: pre-wrap; font-size: 13px; vertical-align: baseline">muscular rigidity (“lead pipe”)</span></p>
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<span style="font-family: Arial; white-space: pre-wrap; font-size: 13px; vertical-align: baseline">hyperthermia (>38 - 40 degrees). </span></p>
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<span style="font-family: Arial; white-space: pre-wrap; font-size: 13px; vertical-align: baseline">Autonomic instability (tachycardia, tachycardia and diaphoresis)</span></p>
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<span style="font-family: Arial; white-space: pre-wrap; font-size: 13px; vertical-align: baseline">Treatment includes discontinuation of the offending agent and providing supportive care.</span></p>
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<span style="font-family: Arial; white-space: pre-wrap; font-size: 13px; vertical-align: baseline">While no clinical trials have ever been undertaken, <u>dantrolene (muscle relaxant)</u> is commonly used.</span></p>
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<span style="font-family: Arial; white-space: pre-wrap; font-size: 13px; vertical-align: baseline">Bromocriptine (dopamine agonist) may also be used, and amantadine (dopaminergic and anticholinergic agent) is used as an alternative to bromocriptone</span></p>
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<span style="text-transform: none; background-color: rgb(255,255,255); text-indent: 0px; font: 13px Arial; white-space: pre-wrap; letter-spacing: normal; color: rgb(34,34,34); vertical-align: baseline; word-spacing: 0px; -webkit-text-stroke-width: 0px">Recently, several case reports have documented the successful use of <u>diazepam</u> as a sole pharmacologic agent. This may be an alternative or a supplement to the above agents</span></p>