Neuroleptic Malignant Syndrome

a) Idiosyncratic drug reaction that can occur at any time, even with stable, chronic doses of neuroleptics

b) Time of onset is typically days, in contrast to serotonin syndrome, which is more acute

c) Characterized by tetrad of fever, ridigity (vs serotonin syndrome, which is characterized by myoclonus), AMS, and autonomic instability (tachycardia, labile BP, tachypnea, arrhythmias)

d) Increased muscle tone can result in rhabdomyolysis

e) Morbidity and mortality is from complications of critical illness

f) Therapy involves stopping offending agent, supportive care (cooling, BP control), and consideration of dantrolene (skeletal muscle relaxant) and bromocriptine (dopamine agonist)

g) If neuroleptics must be restarted, should be done so slowly, and in monitored setting

(Christopher Woo MD, 7/20/10)