Pharmacology · Pathway 29

Neuroleptic Malignant Syndrome

Reference Linear

Key points

NMS: idiosyncratic reaction to dopamine antagonists (antipsychotics, metoclopramide) — more common in young males.
Features: fever (> 38ºC) · muscular rigidity ('lead-pipe') · confusion/reduced consciousness · autonomic dysfunction (labile BP, tachycardia, sweating).
Investigations: raised CK · raised WCC · deranged LFTs.
Management: STOP the antipsychotic; supportive care (cooling, fluids); dantrolene or bromocriptine may be used.
Contrast serotonin syndrome: NMS has bradyreflexia and rigidity (not clonus/diarrhoea).