Neuroleptic Malignant Syndrome Induced by Blonanserin

Abstract

Back to table of contents Previous article Next article LettersFull AccessNeuroleptic Malignant Syndrome Induced by BlonanserinKeiko Ohoyama, M.D., Hisashi Tanii, M.D., Ph.D., Eishi Motomura, M.D., Ph.D., Yoshiaki Konishi, M.S., Masanori Nakagawa, M.D., Takuya Matsumoto, M.D., Ph.D., Takashi Shiroyama, M.D., Ph.D., and Motohiro Okada, M.D., Ph.D.Keiko OhoyamaDepartment of Psychiatry, Mie University Graduate School of Medicine, Tsu, Mie, JapanSuisawa Psychiatric Hospital Yokkaichi, Mie, JapanSearch for more papers by this author, M.D., Hisashi TaniiDepartment of Psychiatry, Mie University Graduate School of Medicine, Tsu Mie, Japan; Brain Science and Animal Model Research Center (BSAM), Mie University, Tsu, Mie, JapanSearch for more papers by this author, M.D., Ph.D., Eishi MotomuraDepartment of Psychiatry, Mie University Graduate School of Medicine, Tsu, Mie, JapanSearch for more papers by this author, M.D., Ph.D., Yoshiaki KonishiDepartment of Psychiatry, Mie University Graduate School of Medicine, Tsu, Mie, JapanSearch for more papers by this author, M.S., Masanori NakagawaDepartment of Psychiatry, Mie University Graduate School of Medicine, Tsu, Mie, JapanSearch for more papers by this author, M.D., Takuya MatsumotoDepartment of Psychiatry, Mie University Graduate School of Medicine, Tsu, Mie, JapanSearch for more papers by this author, M.D., Ph.D., Takashi ShiroyamaDepartment of Psychiatry, Mie University Graduate School of Medicine, Tsu, Mie, JapanSearch for more papers by this author, M.D., Ph.D., and Motohiro OkadaDepartment of Psychiatry, Mie University Graduate School of Medicine, Tsu, Mie, JapanSearch for more papers by this author, M.D., Ph.D.Published Online:1 Jan 2011AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: We report herein, what is, to our knowledge, the first case of neuroleptic malignant syndrome (NMS) related to blonanserin.Case ReportA 30-year-old woman with a diagnosis of mental retardation and with profound intellectual impairment (IQ<45) was admitted to a psychiatric hospital for the first time because of insomnia, psychomotor agitation, monologue, and persecutory delusions. After a 7-day period of medication withdrawal, blonanserin, 8 mg/day, was introduced for psychiatric symptoms such as emotional agitation, auditory hallucinations, and delusions. Her disturbed behavior with high agitation was slightly improved by the medication. After treatment with blonanserin for 7 days, the patient had a high fever (100.4°F) and was obtunded with muscle rigidity. She had a high pulse rate (104 bpm), and an elevated leukocyte level (8.5×109/liter), with extrapyramidal symptoms and perspiration. The patient was suspected to be developing NMS. Blonanserin was discontinued, and the patient received diazepam treatment. The next day, the fever disappeared and the serum leukocyte level was normalized (5.7∼5.9×109/liter). The possibility of infectious disease was excluded since the level of C-reactive protein was within the normal range and all the symptoms disappeared rapidly after treatment for neuroleptic malignant syndrome.DiscussionThis case report shows that neuroleptic malignant syndrome can occur after the introduction of blonanserin treatment. Blonanserin is a novel dopamine-serotonin antagonist with potent dopamine D2 and serotonin 5HT2 antagonist properties.1 Because of the receptor binding profile and pharmacological property of blonanserin, side effects such as extrapyramidal symptoms tend to occur less often with blonanserin than haloperidol.2 This patient had not been medicated with antipsychotic drugs before. Another important issue to be mentioned in this case is mental retardation, which is one of the risk factors for neuroleptic malignant syndrome.3 Several other risk factors should be taken into account in cases involving mentally retarded patients, whose symptoms often include dehydration, agitation, malnutrition, and exhaustion. Special caution with regard to patients who have risk factors for neuroleptic malignant syndrome is therefore necessary when starting to administer antipsychotic drugs.Department of Psychiatry, Mie University Graduate School of Medicine, Tsu, Mie, JapanSuisawa Psychiatric Hospital Yokkaichi, Mie, JapanDepartment of Psychiatry, Mie University Graduate School of Medicine, Tsu Mie, Japan; Brain Science and Animal Model Research Center (BSAM), Mie University, Tsu, Mie, JapanDepartment of Psychiatry, Mie University Graduate School of Medicine, Tsu, Mie, Japan1. Oka M , Noda Y , Ochi Y, et al.: Pharmacological profile of AD-5423, a novel antipsychotic with both potent dopamine-D2 and serotonin-S2 antagonist properties. J Pharmacol Exp Ther 1993; 264:158–165Medline, Google Scholar2. Garcia E , Robert M , Peris F, et al.: The efficacy and safety of blonanserin compared with haloperidol in acute-phase schizophrenia: a randomized, double-blind, placebo-controlled, multicentre study. CNS Drugs 2009; 23:615–625Crossref, Medline, Google Scholar3. Viejo LF , Morales V , Punal P, et al.: Risk factors in neuroleptic malignant syndrome: a case-control study. Acta Psychiatr Scand 2003; 107:45–49Crossref, Medline, Google Scholar FiguresReferencesCited byDetailsCited byNone Volume 23Issue 1 Winter 2011Pages E13-E13 Metrics PDF download History Published online 1 January 2011 Published in print 1 January 2011