Dantrolene for Treatment of Suspected Neuroleptic Malignant Syndrome

Abstract

Neuroleptic malignant syndrome (NMS) is a potentially life-threatening neurologic disorder caused by neuroleptic medications (ie, antipsychotics). Although there is no confirmatory laboratory test, NMS has a distinct clinical presentation that includes changes in mental status, muscle rigidity, hyperthermia, and autonomic nervous system manifestations such as tachycardia, high blood pressure, or increased respiration rate. NMS has an incidence of roughly 0.2% and is challenging to diagnose, with mortality rates estimated at 5.6%. 1 Caroff SN Mann SC Neuroleptic malignant syndrome. Med Clin North Am. 1993; 77: 185-202 Crossref PubMed Scopus (455) Google Scholar , 2 Modi S Dharaiya D Schultz L Varelas P Neuroleptic malignant syndrome: complications, outcomes, and mortality. Neurocrit Care. 2016; 24: 97-103 Crossref PubMed Scopus (51) Google Scholar Faster recognition and diagnosis have likely been the cause of decreased mortality rates over the past decades; however, morbidity is still a significant factor in a patient’s recovery, owing to rhabdomyolysis and organ failure. We report a case of suspected NMS in a patient on multiple neuroleptic medications, successfully treated with dantrolene. Colleen J. Whyte is PGY2 Critical Care Pharmacy Resident, Christiana Care Health System, Newark, DE. Jamie M. Rosini is Emergency Medicine Clinical Pharmacy Specialist, Christiana Care Health System, Newark, DE.