From the Guidelines
Neuroleptic Malignant Syndrome (NMS) treatment requires immediate discontinuation of the causative antipsychotic medication and supportive care, with benzodiazepines as the first-line agent for agitation, and supportive measures such as IV fluids and cooling measures for hyperthermia. The treatment of NMS involves primarily supportive care and removal of the initiating agent, as stated in the study by 1. If NMS is triggered by the abrupt withdrawal of an anti-Parkinsonism drug, reintroduction of the drug may be considered. Cardiorespiratory compromise may be managed with standard, supportive measures. Dehydration or elevated creatine kinase and rhabdomyolysis may be treated with IV fluids.
Key Treatment Components
- Discontinuation of the causative antipsychotic medication
- Supportive care in an intensive care setting
- Benzodiazepines for agitation
- IV fluids for hydration
- Cooling measures for hyperthermia
- Careful monitoring of vital signs, electrolytes, and renal function The study by 1 provides the most recent and highest quality evidence for the treatment of NMS, and its recommendations should be prioritized. Although the study by 1 mentions the use of ECT in adolescents with NMS, it is not the most recent or highest quality study, and its recommendations are not as relevant to the treatment of NMS. Therefore, the treatment of NMS should focus on supportive care, removal of the initiating agent, and management of symptoms, rather than ECT.
From the FDA Drug Label
The management of NMS should include: 1) intensive symptomatic treatment and medical monitoring, and 2) treatment of any concomitant serious medical problems for which specific treatments are available Dopamine agonists, such as bromocriptine, and muscle relaxants, such as dantrolene are often used in the treatment of NMS, however, their effectiveness has not been demonstrated in controlled studies.
The treatment for Neuroleptic Malignant Syndrome (NMS) includes:
- Intensive symptomatic treatment and medical monitoring
- Treatment of any concomitant serious medical problems for which specific treatments are available
- Dopamine agonists, such as bromocriptine, and muscle relaxants, such as dantrolene may be used, but their effectiveness has not been demonstrated in controlled studies 2.
From the Research
Treatment Overview
The treatment for Neuroleptic Malignant Syndrome (NMS) involves a combination of supportive care, discontinuation of antipsychotic medications, and pharmacologic interventions.
- Discontinuation of antipsychotic medications is crucial in the management of NMS 3, 4, 5, 6, 7.
- Supportive care includes aggressive nursing, physical therapy, cooling, rehydration, and anticoagulation 4, 6, 7.
Pharmacologic Interventions
Pharmacologic interventions may include the use of:
- Dantrolene, a peripheral muscle relaxant, which has been found to be effective in treating NMS 3, 4, 5, 6.
- Bromocriptine, a dopamine agonist, which has been used in combination with dantrolene to treat NMS 3, 4, 5, 6.
- Other dopaminergic drugs, such as amantadine and carbidopa/levodopa, which may be considered in the treatment of NMS 5.
Management Guidelines
Management of NMS should be individualized and based on the severity and nature of the symptoms 6.
- A high degree of suspicion and prompt discontinuation of antipsychotic agents are essential for the safety of the patient 6, 7.
- Patients should be monitored daily for dehydration, elevated temperature, and agitation, and vital signs should be checked regularly 7.
- Antipsychotics should be used conservatively, with gradual titration of doses, and rechallenge should not be attempted at least 2 weeks following resolution of symptoms of NMS 7.