- rare but life threatening, idiosyncratic reaction to a neuroleptic medication
- characterised by fever, muscular rigidity, dysautonomia (sweating, tachypnea, tachycardia and labile blood pressure) and altered mental status
- thought to be secondary to decreased dopamine activity in CNS either from blockade of dopamine D2 receptor or decrease availability of dopamine itself
- blockade of dopamine neurotransmission in nigrostriatum and hypothalamus results in muscular rigidity and altered thermoregulation
- most common cause are haloperidol, fluphenazine depot preparation and chlorpromazine
- high creatinine kinase and high white cell counts are seen
- complications include rhabdomyolysis and subsequent renal failure
- stop all neuroleptic, correct volume depletion and hypotension with IV fluid
- bromocriptine 5mg tds is the treatment of choice (dantrolene was formerly recommended as initial treatment of choice although recent studies suggest that it is associated with increased mortality when used without bromocriptine)
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