Neuroleptic rechallenge after neuroleptic malignant syndrome: case report and literature review.

Abstract

Neuroleptic malignant syndrome (NMS) is associated with essentially all of the currently available antipsychotic agents. The signs and symptoms associated with the syndrome are hyperpyrexia, defined by body temperature greater than 38 degrees C; extreme muscle rigidity, with or without elevated creatine phosphokinase or hyperreflexia; and other symptoms such as altered level of consciousness and/or autonomic dysfunction as manifested by labile blood pressure, tachycardia, tachypnea, urinary or fecal incontinence, pallor, or diaphoresis. This potentially fatal syndrome complicates the treatment of patients with recurrent psychotic symptoms because of the possibility for recurrence of the NMS. A case of recurrent NMS is presented in which the patient was rechallenged with an antipsychotic agent. In addition, 41 reported cases of antipsychotic rechallenge after NMS are reviewed. The results of the review suggest that neuroleptic rechallenge following NMS is associated with an acceptable risk of recurrence in most patients. However, close monitoring for NMS and careful selection of patients for antipsychotic rechallenge is mandatory. A minimal time period of five days before rechallenge may also reduce the risk of recurrent NMS. Recurrence was not associated with patient age or gender, nor the antipsychotic agent used.

• Authors: A J Wells, R W Sommi, M L Crismon
• Journal: Drug intelligence & clinical pharmacy (Drug Intell Clin Pharm) Vol. 22 Issue 6 Pg. 475-80 (Jun 1988) ISSN: 0012-6578 [Print] United States
• PMID: 2899492 (Publication Type: Case Reports, Journal Article, Review)

Chemical References

• Antipsychotic Agents

Topics

• Antipsychotic Agents (adverse effects)
• Body Temperature (drug effects)
• Humans
• Male
• Middle Aged
• Neuroleptic Malignant Syndrome (physiopathology)