Hypothermia due to Antipsychotic Medication: A Systematic Review

Abstract

BackgroundHypothermia is a rare, but potentially fatal adverse effect of antipsychotic drug (APD) use. Although the opposite condition, hyperthermia, has been researched extensively in the context of the malignant antipsychotic syndrome, little is known about hypothermia due to APDs.ObjectiveThis study aimed to review the literature on hypothermia in the context of APD use, and formulate implications for research and clinical care.MethodsA systematic search was made in PubMed and Ovid Medline.ResultsThe literature search yielded 433 articles, including 57 original case descriptions of hypothermia developed during APD use with non-toxic plasma levels. All cases together indicate that the risk of developing hypothermia is highest during the 7 days following initiation, or increase in dosage, of APDs, especially in the presence of additional predisposing factors, such as advanced age, exposure to cold, adjuvant use of benzodiazepines, and (subclinical) hypothyroidism. In addition, data derived from drug-monitoring agencies suggest that the prevalence of APD-related hypothermia is at least 10 times higher than suggested by the literature.ConclusionWe conclude that health-care professionals need to monitor the body temperature of patients starting with (an increased dose of) APDs for a duration of 7–10 days to prevent hypothermia, especially in the presence of multiple risk factors. Moreover, systematic studies are needed to establish the actual prevalence of APD-related hypothermia as well as the relative risk for individual APDs.

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

“…A publication from 2017 examined original case reports of possible antipsychotic-induced hypothermia [4]. The risk of hypothermia appears to be highest during the first 7 days of therapy, but may occur after the first dose [1,4,5].…”

“…A publication from 2017 examined original case reports of possible antipsychotic-induced hypothermia [4]. The risk of hypothermia appears to be highest during the first 7 days of therapy, but may occur after the first dose [1,4,5]. Additional factors, such as advanced age, cold exposure, use of benzodiazepines, and hypothyroidism (subclinical), were also noted to predispose a patient on antipsychotics to hypothermia [1,6].…”

“…Additional factors, such as advanced age, cold exposure, use of benzodiazepines, and hypothyroidism (subclinical), were also noted to predispose a patient on antipsychotics to hypothermia [1,6]. Of the 57 case reports analyzed, 52% were with second-generation antipsychotics [4]. These second-generation antipsychoticinduced hypothermia cases were further investigated in a more recent review, which found olanzapine and risperidone to be the most common causes of hypothermia [7].…”

Hypothermia associated with use of paliperidone

“…Hypothermia, a severe life‐threatening condition in which the core body temperature falls below 35°C (95°F), is a less‐known side effect associated with these drugs. Both typical and atypical antipsychotics have been associated with hypothermia, including clozapine, haloperidol, olanzapine, risperidone, and ziprasidone 1 , 2 …”

Hypothermie unter der Gabe von Aripiprazol

“…Des Weiteren zählen metabolische Erkrankungen wie Hypoglykämie, Hypothyreose, Hypopituitarismus, Nebenniereninsuffizienz, Infektionserkrankungen wie Sepsis, Medikation bzw. Intoxikation mit Alkohol-Phenothiazinen, Benzodiazepinen, Cannabis, Narkotika, trizyklischen Antidepressiva, Dilatatoren wie Prazosin und Terazosin, Anästhetika und andere Faktoren wie Niereninsuffizienz, Leberinsuffizienz, Herzinsuffizienz, Mangelernährung und Schock dazu[1].Typischerweise tritt dieselbe Nebenwirkung einer Hypothermie innerhalb von 7 Tagen nach Ansetzen bzw. Dosissteigerung eines Neuroleptikums auf.…”