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Management

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

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

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