What is the duration of hyperthermia after cessation of the offending medication in cases of drug-induced hyperthermia?

From the Guidelines

The duration of hyperthermia after stopping the offending medication in drug-induced hyperthermia varies significantly depending on the specific drug involved, ranging from hours to several days. For neuroleptic malignant syndrome (NMS), hyperthermia typically resolves within 2-3 days after discontinuation but can persist for 7-10 days in severe cases 1. Serotonin syndrome usually resolves within 24 hours of medication cessation 1. Malignant hyperthermia temperature normalizes within hours with proper treatment including dantrolene 1. Anticholinergic toxicity typically resolves within 24-48 hours 1. Some key points to consider in the management of drug-induced hyperthermia include:

• Discontinuation of the offending medication
• Supportive care, such as cooling measures and fluid resuscitation
• Specific antidotes, such as dantrolene for malignant hyperthermia, benzodiazepines for serotonin syndrome, or physostigmine for anticholinergic toxicity
• Monitoring until temperature normalizes and all symptoms resolve completely It's also important to note that the resolution time can be affected by drug factors, such as the medication's half-life, lipophilicity, and active metabolites, as well as patient factors, including age, renal/hepatic function, and hydration status 1. In general, monitoring should continue for at least 24 hours after the event, and patients should be managed in a high dependency unit or ICU if necessary 1. Overall, the management of drug-induced hyperthermia requires a comprehensive approach that takes into account the specific drug involved, the severity of the reaction, and the individual patient's needs.

From the Research

Definition and Causes of Drug-Induced Hyperthermia

• Drug-induced hyperthermia (DIH) is a condition where the body temperature elevates due to the use of certain medications or drugs 2, 3, 4, 5, 6.
• The causes of DIH can be attributed to various drug classes, including anticholinergic drugs, CNS stimulants, salicylates, and combinations of these 3.
• DIH syndromes can be fatal if not recognized promptly and managed appropriately, with symptoms ranging from blood pressure changes and excessive sweating to altered mental status, muscle rigidity, convulsions, and metabolic acidosis 2.

Duration of Hyperthermia after Cessation of the Offending Medication

• The duration of hyperthermia after cessation of the offending medication is not explicitly stated in the provided studies 2, 3, 4, 5, 6.
• However, it is mentioned that the outcome of hyperthermic patients is poor, with some patients experiencing severe permanent neurologic sequelae or death 3.
• The treatment of DIH syndromes includes supportive care and pharmacotherapy as appropriate, with the goal of reducing the duration of hyperthermia and mitigating potentially life-threatening sequelae 2.

Treatment and Management of Drug-Induced Hyperthermia

• The treatment of DIH syndromes includes the immediate discontinuation of the suspected offending agent(s) and supportive care, such as external cooling and volume resuscitation as needed 2.
• Pharmacologic therapy, such as benzodiazepines, bromocriptine, or dantrolene, may be appropriate in some cases, with the selection of a specific agent determined by the medication history and suspected DIH syndrome 2.
• Prevention of death or neurologic sequelae from drug-induced hyperthermia depends upon the recognition of risk factors and the prompt treatment of hyperthermia 3.