Popular Posts
Neuroleptic Malignant Syndrome (NMS): Key Facts
If you or someone you know is taking antipsychotic meds, you’ve probably heard the term "Neuroleptic Malignant Syndrome." It’s not just jargon – it’s a real emergency that can pop up quickly and become deadly if missed. Knowing what triggers it, how it looks, and what to do right away can save lives.
Recognizing the Signs
The first red flag is a sudden, very high fever, often above 101°F (38.3°C). Unlike a regular fever, it comes on fast and doesn’t respond well to typical fever reducers. Coupled with that, the muscles become extremely stiff – think “lead‑pipe” rigidity that makes moving or even opening the mouth painful.
Next, the body’s automatic systems go haywire. Blood pressure can swing wildly, heart rate spikes, and you might see sweating, tremors, or irregular breathing. Mental status also changes – patients can become confused, agitated, or slip into a coma.
Lab tests back up the picture. Creatine kinase (CK) levels soar, sometimes ten times normal, because the muscles are breaking down. White blood cells rise, and electrolytes can get out of balance. All these clues together point to NMS.
How to Treat NMS
Speed matters. The first step is to stop the offending antipsychotic immediately – even a single dose can keep the reaction going. Then, move the patient to an intensive care setting where doctors can control temperature, hydrate aggressively, and monitor heart and lung function.
Medication helps too. Dantrolene, a muscle relaxant, lowers rigidity and fever by stopping the muscle’s calcium overload. Bromocriptine, a dopamine‑stimulating drug, can reverse the dopamine blockade that started the syndrome. Some clinicians add amantadine for the same reason.
Supportive care rounds out the plan. Cool blankets, IV fluids, and electrolytes keep the body stable. In severe cases, dialysis may be needed to clear excess CK and protect the kidneys. Most patients improve within a week if treatment starts early, but recovery can take longer, and the underlying psychiatric condition still needs attention.
Prevention is also key. Doctors should start with the lowest effective antipsychotic dose, avoid rapid dose jumps, and watch closely for early warning signs, especially in people with a history of NMS or other risk factors like dehydration or high muscle mass.
Bottom line: Neuroleptic Malignant Syndrome is rare, but when it shows up, every minute counts. Spotting rapid fever, stiffness, and autonomic chaos, then acting fast to stop the drug and start aggressive care, gives the best chance for a full recovery.
Clozapine and Neuroleptic Malignant Syndrome: Spotting the Warning Signs
- By : Tamsin Riverton
- Date : Aug 12 2025
Learn how clozapine can trigger neuroleptic malignant syndrome, recognise early warning signs, and manage the emergency with practical guidance.