Neuroleptic malignant syndrome: a complication of neuroleptics and cocaine abuse

One hundred and sixty psychiatric patients on Neuroleptics, with and without a history of substance abuse were daily monitored in order to establish the incidence of neuroleptic malignant syndrome in these two groups. Four (5.1%) of the cocaine abusers and none of the non-cocaine abusers developed neuroleptic malignant syndrome when treated with neuroleptics. Thus we argue that psychiatric patients with a history of cocaine abuse may be more at risk of developing neuroleptic malignant syndrome when treated with neuroleptics, possibly associated with the blockade of dopamine (D2-receptors) by neuroleptics and the activation of dopamine/5-HT receptors by cocaine-induced dopamine.