Algorithms for the treatment of acute side effects induced by neuroleptics

This article focuses especially on acute extrapyramidal symptoms (EPS) and neuroleptic malignant syndrome (NMS) induced by antipsychotic treatments. Strategies for the management of acute EPS may include changing the neuroleptic (NL) to an alternative one, i.e. switching to a low-potency or an atypical antipsychotic, lowering the dosage or discontinuing the NL, and adding a drug effective in treating EPS. The important factors in the management of NMS are early recognition, immediate discontinuation of antipsychotic medications and prompt institution of supportive care. Dantrolene and/or bromocriptine are found to be the most effective for the second-step treatment of NMS in Japan.