RevisePsych

• Idiosyncratic side effect primarily associated with antipsychotics

 

• Marked by

- muscular rigidity pyrexia,

- autonomic instability (unstable BP, tachycardia, increased sweating,  increased salivation, urinary incontinence),

- decreased consciousness,

- increased creatinine kinase (CPK),

- leucocytosis,

- low serum iron

 

• Medical emergency that can lead to death.

 

• Treatment 

- stop neuroleptic, treat hyperthermia aggressively.

- May need ICU.

- Dopamine agonists (dantrolene), benzodiazapines for agitation.

- Aggressive hydration with diuresis as myoglobin levels may result in renal failure.

 

• Early recognition needed, however 10% fatal.

Neuroleptic Malignant Syndrome (NMS)