management

Last reviewed 01/2018

This is dependent on the severity of the condition.

If the full blown condition is present (fever, rigidity, autonomic instability, altered consciousness) then:

• treatment is with immediate cessation of neuroleptics, rehydration, and correction of fever and acidosis
• during an episode the use of electroconvulsive therapy and benzodiazepines are considered to be safe
• rechallenge with neuroleptics is probably safe if a gap of 2 weeks has been left between resolution of the neuroleptic syndrome and the reintroduction of the drug
• use of dantrolene and bromocriptine is unproven

In mild or early cases then management is more controversial:

• withdrawal of neuroleptics may delay resolution or worsen the psychosis, and withdrawing them from every patient with fever and rigidity would be questionable