Neuroleptic malignant syndrome associated with metoclopramide antiemetic therapy

Bakri, Younes N.; Khan, Rubina; Subhi, Jamal; Kawi, Z al

doi:10.1016/0090-8258(92)90037-j

Cited by 17 publications

(15 citation statements)

References 5 publications

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“…4 A number of cases of NMS after a single dose of metoclopramide, occurring in a non-psychiatric patients have been reported in the literature. 5 " 14 The interesting observation in this case was the prompt response to the anti-cholinergic drug procyclidine. Furthermore, this anti-muscarinic drug caused a decrease in heart rate and an increase in bowel activity, the opposite of its expected effects when delivered intravenously in high dosage.…”

Section: Discussionmentioning

confidence: 77%

Paradoxical Autonomic Response to Procyclidine in the Neuroleptic Malignant Syndrome

Balzan

1995

Can. j. neurol. sci.

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Background: Neuroleptic Malignant Syndrome (NMS) is an adverse reaction to dopamine receptor antagonists, characterised by hyperpyrexia, extrapyramidal rigidity and impaired autonomic function. It might result from central dopamine receptor blockade that causes severe muscle contraction. Method: Case Study. Results: High dose intravenous therapy with the anticholinergic drug, procyclidine hydrochloride, temporarily diminished the muscle rigidity and reversed most of the autonomic features in a patient with NMS occurring after a single intramuscular dose of the dopamine antagonist metoclopramide. Paradoxically, however, the heart rate decreased and bowel movements increased with this atropine-like drug. Conclusion: Since the degree of tachypnoea, tachycardia, and bowel hypotonia closely paralleled the severity of the muscle rigidity, it is suggested that these autonomic features of NMS result from sustained muscle contraction rather than a direct effect of neuroleptic drugs on the central nervous system. RESUME: Reponse neurovegetative paradoxale a la procyclidine dans le syndrome malin des neuroleptiques. Introduction: Le syndrome malin des neuroleptiques (SMN) est une reaction ind£sirable aux antagonistes des rScepteurs dopaminergiques caracterisee par une hyperthermie, une rigidite extrapyramidale et une dysfonction neurovegetative. Ce syndrome peut resulter d'un blocage des recepteurs dopaminergiques causant des contractions musculaires graves. Methodes: II s'agit d'une etude de cas. Resultats: Le chlorhydrate de procyclidine, un anticholinergique administre a haute dose par voie intraveineuse, a diminud temporairement la rigiditd musculaire et a corrige' la plupart des manifestations neurovegetatives chez un patient pr&entant le SMN a la suite d'une seule injection intramusculaire d'un agoniste de la dopamine. Paradoxalement, le rythme cardiaque a ralenti et le peristaltisme intestinal a augmente. Conclusions: Comme le degre de tachypnee, de tachycardie et d'hypotonie intestinale etaient en parallele etroit avec la severite de la rigidite musculaire, nous suggeYons que ces manifestations neurovegetatives du SMN resultent de la contraction musculaire soutenue plutot que d'un effet direct des substances neuroleptiques sur le systeme nerveux central.Can. J. Neurol. Sci. 1995; 22: 244-246 The neuroleptic malignant syndrome (NMS) is a rare serious adverse reaction to central dopamine receptor antagonists, characterised by hyperpyrexia, severe extrapyramidal rigidity and autonomic dysfunction. It has been suggested that this syndrome occurs as a result of massive central dopamine receptor blockade with consequent severe muscle contraction. Hyperpyrexia is thought to occur because of increased muscle heat production together with ineffective heat dissipation. However, whether the autonomic features are due to the direct action of neuroleptics on the central nervous system, or if they are the result of the muscle rigidity and body overheating remains unclear. ' 2 This is a report of a case of NMS caused...

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Section: Discussionmentioning

confidence: 77%

Paradoxical Autonomic Response to Procyclidine in the Neuroleptic Malignant Syndrome

Balzan

1995

Can. j. neurol. sci.

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“…Although neuroleptic drugs, including haloperidol, chlorpromazine, sulpiride, prochlorperazine, tiapride and metoclopramide, are widely prescribed in clinical oncology, including palliative medicine, NMS has rarely been reported in cancer patients. According to MEDLINE, between 1983 and 1997 only three cases were detected [2,7,9].…”

Section: Discussionmentioning

confidence: 99%

Neuroleptic malignant syndrome during haloperidol treatment in a cancer patient

Tanaka

Akechi

Yamazaki

et al. 1998

Supportive Care in Cancer

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A case of neuroleptic malignant syndrome (NMS) in a 64-year-old man with cancer of the soft palate is reported. During haloperidol treatment for delirium, the patient showed consciousness disturbance with extrapyramidal signs. With discontinuation of haloperidol and replacement by dantrolene and bromocriptine, the patient recovered completely. Although major tranquilizers are widely used in clinical oncology to manage symptoms, NMS has been rarely reported in cancer patients, presumably because of lack of awareness. Early recognition of NMS and prompt treatment may improve the potentially fatal outcome.

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“…The medications most commonly implicated in NMS are antipsychotic drugs. Other drugs that act as dopamine antagonists also have been associated with NMS but to a lesser degree than the antipsychotics; these other drugs include prochlorperazine, [8][9][10] metoclopramide, [11][12][13] droperidol, 14,15 and promethazine. 16,17 The risk of developing NMS appears to correlate with the dose, potency, and rate and route of administration of dopamine antagonists.…”

Section: Nmsmentioning

confidence: 99%