Provides clinical guidelines for the treatment of neuroleptic malignant syndrome and the safe reinstitution of neuroleptic medications.
Supports bromocriptine and dantrolene in NMS; reinforces Level 1 guidelines for acute care and safe neuroleptic resumption.
The neuroleptic malignant syndrome (NMS) is a dangerous, often fatal, idiosyncratic disorder presumably of the basal ganglia and hypothalamus. It is usually associated with neuroleptic medications, and it is believed to be related to blockage of dopamine receptors in the brain. The NMS has also been reported in patients with Parkinson's disease after withdrawal of antiparkinsonian agents during "drug holidays." Cardinal features include fever, muscular rigidity, an elevated serum level of creatine phosphokinase, changes in mental status, and autonomic dysfunction. Although treatment has been largely supportive, dopamine agonists, such as bromocriptine, and a direct-acting muscle relaxant, dantrolene, have been used with good clinical outcome. Guidelines for reinstitution of neuroleptics are suggested.
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Thomas R. Olmsted (1988) conducted a review in Neuroleptic Malignant Syndrome. Dopamine agonists (e.g., bromocriptine) and dantrolene was evaluated. Dopamine agonists such as bromocriptine and the direct-acting muscle relaxant dantrolene have been used with good clinical outcomes in the treatment of neuroleptic malignant syndrome.
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