UMEM Educational Pearls

Category: Airway Management

Title: Neuroleptic Malignant Syndrome

Keywords: NMS, haldol, haloperidol, fluphenazine, dantrolene, bromocriptine, diazepam (PubMed Search)

Posted: 9/5/2013 by Ellen Lemkin, MD, PharmD
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NMS is most often seen with the typical high potency neuroleptic agents (e.g haldol, fluphenazine)

All classes of antipsychotics can cause NMS, including low potency and newer atypical agents; antiemetics can cause this as well.

Symptoms usually occur after the first 2 weeks of therapy, but may occur after years of use

Signs and symptoms include:

mental status changes

muscular rigidity (“lead pipe”)

hyperthermia (>38 - 40 degrees).

Autonomic instability (tachycardia, tachycardia and diaphoresis)

Treatment includes discontinuation of the offending agent and providing supportive care.

While no clinical trials have ever been undertaken, dantrolene (muscle relaxant) is commonly used.

Bromocriptine (dopamine agonist) may also be used, and amantadine (dopaminergic and anticholinergic agent) is used as an alternative to bromocriptone

Recently, several case reports have documented the successful use of diazepam as a sole pharmacologic agent. This may be an alternative or a supplement to the above agents