Neuroleptic Malignant Syndrome

By | June 8, 2022

A neuroleptic malignant syndrome ( MNS for short ) is also referred to as a neuroleptic malignant syndrome. This is a rare side effect that results from taking neuroleptics.

What is Neuroleptic Malignant Syndrome?

The neuroleptic syndrome is a rare but life-threatening clinical picture, which is triggered by dopamine antagonists (especially neuroleptics ), but also by lithium or antidepressants. It usually occurs with a high dosage of the medication or a rapid increase in the dose in the first four weeks after the start of therapy or the change of medication. For jmml – juvenile myelomonocyte leukemia, please visit

Neuroleptic syndrome is said to appear in around 0.2 percent of patients treated with neuroleptics. The clinical picture was observed most frequently when taking haloperidol, but in principle also with all other neuroleptics. In addition, individual familial cases are known, so that a genetic component with regard to the development of the disease cannot be ruled out.

A malignant neuroleptic syndrome is a dreaded emergency in psychiatry because the clinical picture progresses quickly and can also quickly trigger life-threatening complications.


Drugs that may trigger Neuroleptic Malignant Syndrome include:

  • aripiprazole
  • carbamazepine
  • Low-potency neuroleptics such as chlorpromazine, perazine, pipamperone and triflupromazine
  • Thioxanthenes: Chlorprothixen and Flupentixol
  • Tricyclic antidepressants: desipramine and trimipramine
  • Phenothiazine prokinetics: domperidone and metoclopramide
  • Common phenothiazines: fluphenazine and perphenazine
  • Butyrophenones: haloperidol, benperidol and melperone
  • lithium
  • pimozide
  • Atypical neuroleptics: risperidone and aripiprazole
  • SSRIs: sertraline and escitalopram
  • SNRI: tiapride
  • Benzamides: Amisulpride

Other risk factors such as taking strong antipsychotic neuroleptics and high dosages can promote malignant neuroleptic drug syndrome. Existing brain damage and thyroid disease can also have an impact on the development of a neuroleptic malignant syndrome. This also applies to physical exhaustion, dehydration or hyponatremia.

Symptoms, Ailments & Signs

A neuroleptic malignant syndrome causes various symptoms such as extrapyramidal motor disorders, extreme muscle stiffness or spasms. Those affected sweat profusely, sometimes breaking out in a sweat, tachycardia and tachypnea occur. Heart palpitations, rapid breathing and changes in blood pressure, urinary or fecal incontinence have also been observed in such a case.

Furthermore, speech and swallowing disorders, increased salivation and an increase in body temperature can occur. Confusion, impaired consciousness and even coma are associated with Neuroleptic Malignant Syndrome.

In most cases, Neuroleptic Malignant Syndrome begins within less than 10 days of initiating therapy with the causative drug. Rarely this can take up to two months. Within two days, but sometimes even after a few hours, the neuroleptic malignant syndrome usually develops into a full picture.

Diagnosis & course of disease

In order to make the diagnosis that a malignant neuroleptic syndrome is present, first of all general measures are carried out, for example measuring fever and blood pressure. The latter can be either high or low, but is also often unstable. Other signs are usually an increase in CPK, but can also be only slight, increased LDH (lactate dehydrogenase), leukocytosis, proteinuria and myoglobinuria.

In addition, there is hyponatremia and hypernatremia, a slight increase in protein in the CSF, low serum iron, serum calcium and magnesium. Diagnosis and treatment as early as possible are very important in order to avoid consequential damage. A serious complication that can cause Neuroleptic Malignant Syndrome is rhabdomyolysis with myoglobinuria.

This can lead to acute kidney failure. Other risks include hyperthermia, which can potentially cause dehydration, which in turn can cause phlebothrombosis and pulmonary embolism. Seizures are also possible.

In the worst case, a neuroleptic malignant syndrome can lead to multi- organ failure. The cloudiness and in particular the muscular rigidity and the fever can increase rapidly and very quickly lead to life-threatening decompensation. Therefore, treatment is essential.


Neuroleptic syndrome usually causes many different symptoms. However, they do not always point directly to the syndrome, so that in many cases treatment is delayed. As a rule, those affected suffer from a greatly increased sweating and also from severe sweating. These can significantly restrict and reduce the quality of life.

It is also not uncommon for neuroleptic syndrome to cause tachycardia, which in the worst case can lead to a heart attack. Those affected suffer from fecal incontinence, which often leads to depression and other psychological upsets. Those affected also continue to suffer from fever and, if the disease is not treated, often from renal insufficiency. This can lead to death and the person affected is then dependent on dialysis or a donor kidney.

Neuroleptic syndrome is treated relatively easily and quickly with the help of medication and an increased intake of fluids. Complications do not arise and the complaints can be resolved relatively easily. As a rule, with early treatment, the life expectancy of the patient is not reduced by the neuroleptic syndrome.

When should you go to the doctor?

People who are under the influence of a drug from the neuroleptic series should consult a doctor in the event of negative changes in their state of health. If there are disturbances of the motor function or the heart rhythm, a medical clarification of the complaints is necessary.

A doctor should be consulted in the event of heart palpitations, increased blood pressure, outbreaks of sweating, increased oxygen requirements or other vegetative irregularities. If breathing is difficult or if the affected person suffers from accelerated breathing, a doctor should be consulted. Communication problems are also a cause for concern. If you have trouble speaking or swallowing, see a doctor.

A dry mouth and throat, an interruption in the regular natural flow of saliva and an increased body temperature are signs of an existing irregularity. A doctor’s visit is necessary so that the treatment plan developed for the treatment of the underlying disease can be optimized. If there is an irregularity in the digestive tract, incontinence or problems with going to the toilet, a doctor should be consulted.

If the patient becomes mentally confused or becomes unconscious, a doctor must be informed of the observations, as these are important warning signs of the organism. In the event of a loss of consciousness, an emergency service must be alerted. The person concerned requires first aid from those present until the emergency physician arrives.

Treatment & Therapy

The primary course of action, if Neuroleptic Malignant Syndrome is diagnosed, is to immediately discontinue the causative neuroleptic drug or offending antipsychotic drug. All other measures serve more as support and relate primarily to securing the important vital functions. If necessary, this includes ventilation, rehydration and the avoidance of further complications.

The fluid and electrolyte loss must be compensated for and the fever must be reduced as quickly as possible with medication. Sometimes, in difficult cases, temporary dialysis may be necessary. Muscle relaxants and dopamine agonists are also effective support. Further measures include monitoring such as an ECG, volume substitution and thrombosis prophylaxis.

In severe cases or if there is no improvement after 24 hours, Dantrolene is used. This is the case with increased muscle tension, which leads to severe muscle spasms. Due to the fact that neuroleptic malignant syndrome is a life-threatening disease, it is treated in the intensive care unit.

Outlook & Forecast

Without prompt medical care, the prognosis of this syndrome is poor. It is a life-threatening condition that requires action as soon as possible. Otherwise, the victim will die prematurely. The disease is triggered by a side effect of medical preparations prescribed by a doctor for the treatment of an existing primary disease. For this reason, the additional symptoms can be alleviated if cooperation with the treating doctor is sought.

As soon as the first health problems appear, the doctor who is treating the underlying disease should be consulted. A change in the treatment plan that has been worked out is necessary so that the malignant neuroleptic syndrome can regress and be fully treated. The administration of alternative medicines alleviates the health irregularities that have occurred. The unwanted side effects gradually disappear if you react as quickly as possible. Otherwise, in addition to the development of a life-threatening condition, irreparable damage to the organism can also occur.

The risk of impairment of kidney activity is significantly increased by the triggering medication. If the course of the disease is unfavorable, permanent complications can occur despite all efforts. In addition, seizures can occur, which can also trigger irreversible changes. An improved prognosis is achieved by promptly initiating an increased intake of fluids in addition to consulting the doctor.


Since neuroleptic malignant syndrome usually occurs as a side effect of medication, it is not possible to prevent the disease, but only to avert it by immediately stopping the medication that caused it. For this it is important to pay close attention to possible side effects and changes in relation to the body when taking it and to take them very seriously.

Since the likelihood of a malignant neuroleptic syndrome recurring is significantly increased, it is also very important to approach the restart of neuroleptic therapy very carefully and sensitively. Ideally, atypical neuroleptics are prescribed, which are taken in the lowest possible dose in order to keep the risk low from the start. It is also important, if a change of doctor is pending, to inform a new doctor about the previous illness if the use of corresponding medication is planned.


A drug allergy is usually not curable. In order to avoid symptoms, the patient must discontinue the drug in question and no longer take it in the future. This is the only way to prevent the disease from recurring. This requires a high degree of personal responsibility in everyday life.

Follow-up care in the case of neuroleptic syndrome is basically aimed at preventing complications. This is particularly important in life-threatening situations. With treatment occurring within minutes, such knowledge can be vital. Because drug intolerance is constant, the most effective follow-up care is protection from dangerous consequences. This can only be done by avoiding any substances.

You can do that yourself

If irregularities or abnormalities occur when taking neuroleptics, the person concerned should, in his own interest, seek a conversation with the doctor treating him. Since the neuroleptic malignant syndrome is treated in an intensive care unit, the possibilities for self-help are very limited. Delays in consulting a doctor lead to a rapid deterioration in health and should be avoided.

The disease is associated with numerous symptoms and complaints, which often represent an overload for the patient and their relatives. Emerging fears and worries of all those involved should not become too strong. Climbing in is urgently to be avoided. The exchange with relatives, therapistsor those who are also ill can be helpful. Language barriers can be overcome with digital tools or sign language. Basically, a positive basic attitude towards life and its challenges is important. They help to cope with events and lead to new possible solutions. Thinking should be positive and realistic at the same time. It is helpful to set new goals that are achievable and do not cause further stress.

In order not to suffer from additional illnesses, a healthy lifestyle is important. A healthy diet, optimized sleeping conditions and the supply of sufficient oxygen strengthen the immune system and promote well-being. At the same time, the consumption of harmful substances such as alcohol or nicotine should be avoided.

Neuroleptic Malignant Syndrome