Neuroleptic malignant syndrome (NMS) is rare but one of the most serious adverse effects of antipsychotics. Here, we report a case of risperidone-associated NMS in which a successful rechallenge of risperidone was observed with a positive follow-up.
What drugs can cause neuroleptic malignant syndrome?
NMS is usually caused by antipsychotic drug use, and a wide range of drugs can result in NMS. Individuals using butyrophenones (such as haloperidol and droperidol) or phenothiazines (such as promethazine and chlorpromazine) are reported to be at greatest risk.
Can risperidone cause NMS?
Clinicians need to be aware that NMS can occur with risperidone, despite the markedly lower incidence of extrapyramidal symptoms. In patients with neurodegenerative disorders, caution should be exercised in prescribing even atypical agents, and a high index of suspicion for NMS should be maintained.
What antipsychotics cause neuroleptic malignant syndrome?
Atypical antipsychotic drugs that may cause NMS include the following:
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Can atypical antipsychotics cause neuroleptic malignant syndrome?
Neuroleptic malignant syndrome (NMS) is a rare but potentially fatal adverse event associated with the use of antipsychotics. Although atypical antipsychotics were initially considered to carry no risk of NMS, reports have accumulated over time implicating them in NMS causation.
What is the treatment for neuroleptic malignant syndrome?
In more severe cases of NMS, empiric pharmacologic therapy is typically tried. The two most frequently used medications are bromocriptine mesylate, a dopamine agonist, and dantrolene sodium, a muscle relaxant that works by inhibiting calcium release from the sarcoplasmic reticulum.
What does neuroleptic malignant syndrome look like?
Symptoms of neuroleptic malignant syndrome usually include very high fever (102 to 104 degrees F), irregular pulse, accelerated heartbeat (tachycardia), increased rate of respiration (tachypnea), muscle rigidity, altered mental status, autonomic nervous system dysfunction resulting in high or low blood pressure, …
How do you test for neuroleptic malignant syndrome?
However, the following laboratory studies may be indicated, to assess severity and complications or rule out other diagnostic possibilities:
- Complete blood count (CBC)
- Blood cultures.
- Liver function tests (LFTs)
- Blood urea nitrogen (BUN) and creatinine levels.
- Calcium and phosphate levels.
- Creatine kinase (CK) level.
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How can you prevent neuroleptic malignant syndrome?
The most important aspect of treatment is prevention. This includes reducing risk factors (e.g. dehydration, agitation and exhaustion), early recognition of suspected cases and prompt discontinuation of the offending agent.
How is neuroleptic malignant diagnosed?
The diagnosis is confirmed by the presence of recent treatment with neuroleptics (within the past 1-4 weeks), hyperthermia (temperature above 38°C), and muscular rigidity, along with at least five of the following features: Change in mental status Tachycardia. Hypertension or hypotension.
Is NMS reversible?
After recovery, most people can start taking antipsychotic medicine again. Your doctor might switch you to a different drug. NMS can come back after you’re treated.
Can antidepressants cause neuroleptic malignant syndrome?
Antipsychotic and antidepressant are often used in combination for the treatment of neuropsychiatric disorders. The concomitant use of antipsychotic and/or antidepressant with drugs that may interact can lead to rare, life-threatening conditions such as serotonin syndrome and neuroleptic malignant syndrome.
What is the difference between NMS and serotonin syndrome?
NMS and serotonin syndrome are rare, but potentially life-threatening, medicine-induced disorders. Features of these syndromes may overlap making diagnosis difficult. However, NMS is characterised by ‘lead-pipe’ rigidity, whilst serotonin syndrome is characterised by hyperreflexia and clonus.
Is neuroleptic malignant syndrome the same as malignant hyperthermia?
Malignant hyperthermia is extremely rare in the postoperative setting, and serotonin syndrome has a faster onset and neuromuscular hyperactivity while neuroleptic malignant syndrome has a slower onset and neuromuscular hypoactivity.
Is neuroleptic malignant syndrome a extrapyramidal symptoms?
Antipsychotic medications commonly produce extrapyramidal symptoms as side effects. The extrapyramidal symptoms include acute dyskinesias and dystonic reactions, tardive dyskinesia, Parkinsonism, akinesia, akathisia, and neuroleptic malignant syndrome.