Antipsychotic-Related Hypothermia: Five New Cases

Abstract

Background: Hypothermia is a potentially fatal adverse effect of antipsychotic drug (APD) use. With only 69 cases described in the literature, the condition is considered rare. Methods: We describe five new cases, in which we estimated the role of clozapine, haloperidol, olanzapine, penfluridol, risperidone, and zuclopentixol with the aid of two structured assessment tools. Results: In addition to APD use, all five patients described by us had been exposed to one or more additional predisposing factors for hypothermia. Therefore, with the aid of the assessment tools, the causal role of APDs was considered “possible” in four cases of moderate hypothermia and “doubtful” in the remaining one of mild hypothermia. Conclusion: Although the best way to detect APD-related hypothermia is measuring the body temperature for a duration of at least 7–10 days after the start (or a dose increase) of APDs, the use of assessment tools to identify additional predisposing factors for hypothermia and to thus establish their causal relationship with APD use would seem to be valuable for clinical decision-making (i.e., whether or not to discontinue APD use). Further research is needed to obtain reliable prevalence figures for APD-related hypothermia and its consequences, preferably in relation with physiological changes in body temperature.

Characteristics of antipsychotic drug‐induced hypothermia in psychogeriatric inpatients

“…Typically, risperidone dosage in the elderly does not exceed 1–2 mg/d (Uchida & Mamo, 2009). Most reported cases of risperidone‐induced hypothermia refer to patients with higher dosages (up to 6–8 mg/d) (Nagamine, 2016; Perera & Yogaratnam, 2014; Zonnenberg et al., 2019). Hypothermia associated with pipamperone has been reported in numerous previous studies and case reports (Kamp, Paschali, & Lange‐Asschenfeldt, 2016; Kamp, Paschali, Supprian, et al., 2016; van Marum et al., 2007; Zonnenberg et al., 2017, 2019).…”

A case report of acute hypothermia during initial inpatient clozapine titration with review of current literature on clozapine-induced temperature dysregulations

“…Although one report speculated clozapine may be safely utilized in those with a history of hypothermia from alternative antipsychotics, newer reports suggests this may not be the case [8,9]. Here we present a unique case of hypothermia occurring on initial titration of clozapine during an inpatient psychiatry admission.…”

Experimental Serotonin Syndrome: Effects of GABA-ergic Medications and 5-HT2-Antagonists

“…Moreover, temperature dysregulation is a documented side effect of antipsychotic drugs [68][69][70][71][72]. That most often manifests in the development of hyperthermia, a life-threatening symptom characteristic of the malignant neuroleptic syndrome (MNS).…”

“…That most often manifests in the development of hyperthermia, a life-threatening symptom characteristic of the malignant neuroleptic syndrome (MNS). Data from various clinical cases, summarized in recent years by van Marum [68] and Zonnenberg [69,70], show that the use of classical or atypical antipsychotics carries the risk of developing another, less well-documented adverse drug reaction, namely hypothermia. In humans, hypothermia is defined as a body temperature below 35 ° C, distinguishing three degrees: mild (33-35 ° C), moderate (28-33 ° C) and severe (<28 ° C) hypothermia [69].…”