Therapy of neuroleptic malignant syndrome

The neuroleptic malignant syndrome (NMS) is an under-recognized yet sometimes fatal complication of antipsychotic drug therapy. NMS is comprised of hyperthermia, rigidity, autonomic disturbances, and altered consciousness. Until recently, there was no specific therapy for NMS other than discontinuing the offending neuroleptic and providing symptomatic treatment. However, 4 drugs (dantrolene and the dopamine agonists amantadine, bromocriptine, and carbidopa/levodopa) have clearly emerged to merit consideration in the therapy of NMS. The literature on their use in this disorder, either alone or in combination, is reviewed. The combination of dantrolene (a peripheral muscle relaxant) and post-synaptic dopamine agonists may prove the most effective in this condition.