Abstract
<h3>To the Editor.—</h3> In the Nov 15, 1985, issue of<i>JAMA</i>, Drs Sangal and Dimitrijevic<sup>1</sup>describe a case of the neuroleptic malignant syndrome (NMS). The subtitle of their article is "Successful Treatment With Pancuronium." While we recognize the presumed activity of neuromuscular blockade in this case, the inclusion of propranolol and diazepam in the treatment regimen should not be overlooked (eg, 0.5 mg of propranolol hydrochloride intravenously every two to four hours; 4 mg of diazepam intravenously every two to four hours). Feibel and Schiffer, in an often-cited report,<sup>2</sup>describe the elevation of plasma and urine catecholamine levels in NMS. They reasonably infer both a sympathetic contribution to the pathogenesis of the syndrome, as well as an application for β-adrenergic blockage in its treatment. In addition, although not a commonly chosen therapy for NMS, diazepam is reported to have been effective in multiple cases.<sup>3,4</sup> In the case
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