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Published on: November 21, 2013
Neuroleptic malignant syndrome during a change from haloperidol to risperidone
R R Reeves1, J E Mack, R A Torres
1GV (Sonny) Montgomery Veterans Administration Medical Center, USA. roy.reeves2@med.va.gov
The Annals of Pharmacotherapy
|June 21, 2001
Summary
Neuroleptic Malignant Syndrome (NMS) can occur when switching antipsychotics like haloperidol to risperidone. Close monitoring is crucial during medication changes to prevent serious adverse events.
Area of Science:
- Psychiatry
- Pharmacology
- Clinical Neuroscience
Background:
- Neuroleptic Malignant Syndrome (NMS) is a rare but life-threatening reaction to antipsychotic medications.
- Switching antipsychotic medications, particularly from older to newer agents, requires careful clinical consideration.
Observation:
- A case of NMS developed in a patient within 48 hours of adding risperidone and mirtazapine to haloperidol therapy.
- Symptoms included fever, generalized rigidity, and altered mental status, resolving with supportive care and specific treatments.
Findings:
- NMS likely resulted from combined dopamine 2 receptor blockade by haloperidol and risperidone.
- Mirtazapine-induced sympathetic hyperactivity may have contributed to the NMS presentation.
Implications:
- Clinicians must exercise caution when co-prescribing or switching between antipsychotics like haloperidol and risperidone.
- Discontinuation of one antipsychotic before initiating another may pose a risk of relapse, necessitating vigilant patient monitoring.
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