Neuroleptic malignant syndrome: Answers to 6 tough questions
Empiric evidence clarifies risk factors, causes, and first-line interventions.
6. Are antipsychotics contraindicated following an NMS episode?
The rate of NMS recurrence on retreatment with an antipsychotic has varied.38 We estimate that up to 30% of patients may be at risk of NMS recurrence when rechallenged with an antipsychotic.1 By following proper precautions (Table 2), however, you can safely treat most patients who require continued antipsychotic therapy.1,2 When you restart treatment, a lower-potency antipsychotic from a different chemical class may be a safer option than retrying the triggering agent, according to retrospective analyses of limited available data. A patient who develops NMS on a FGA might benefit from an SGA trial, although some risk of recurrence remains.1,10
Current Psychiatry 2007;6(8):89-95.
Drug brand names
- Amantadine • Symmetrel
- Bromocriptine • Parlodel
- Chlorpromazine • Thorazine
- Dantrolene • Dantrium
- Fluphenazine • Prolixin
- Haloperidol • Haldol
- Lorazepam • Ativan
- Loxapine • Loxitane
- Perphenazine • Trilafon
- Prochlorperazine • Compazine, Compro
- Promethazine • Phenergan
- Thioridazine • Mellaril
Disclosure
Dr. Strawn is an American Psychiatric Institute for Research and Education (APIRE)/Janssen Scholar.
Dr. Keck has received research support from or served as a consultant to Abbott Laboratories, American Diabetes Association, AstraZeneca Pharmaceuticals, Bristol-Myers Squibb, GlaxoSmithKline, Eli Lilly and Company, Janssen Pharmaceutica, National Institute of Mental Health, National Institute of Drug Abuse, Pfizer, Stanley Medical Research Institute, and UCB Pharma.
Dr. Caroff has received research support from Bristol-Myers Squibb, Ortho-McNeil Neurologics, and Pfizer.
