Bromocriptine

Key points

• A picture identical to neuroleptic malignant syndrome — hyperthermia, rigidity, altered consciousness, autonomic instability and a raised creatine kinase — but with NO neuroleptic exposure should raise PARKINSONISM-HYPERPYREXIA SYNDROME.
• It is triggered by abrupt withdrawal or sudden dose reduction of dopaminergic therapy in Parkinson's disease — which is why levodopa must never be stopped suddenly and inpatients need their doses on time.
• Management: reinstate the dopaminergic medication urgently, with supportive care (fluids, cooling, monitoring for rhabdomyolysis and acute kidney injury) · bromocriptine is among the dopaminergic agents used.