A case of neuroleptic malignant syndrome in a patient with hemodialysis

Abstract

A 63-year-old man with chronic renal failure who had received hemodialysis three times per week for 4 years developed neuroleptic malignant syndrome 10 days after taking amoxapine. His condition was characterized by muscle rigidity, elevation of body temperature and altered consciousness.Although he was treated with dantrolen and supportive care as well as discontinuation of amoxapine, his condition rapidly deteriorated, resulting in death. Because the pharmacokinetics of drugs, especially those such as antidepressants, in patients with chronic renal failure has not been fully clarified, one should be careful about giving such patients these drugs.

Successful Treatment of Six Patients with Neuroleptic Malignant Syndrome Associated with Myoglobulinemic Acute Renal Failure

“…[15] The patient's symptoms disappeared after the administration of dopamine agonist. [15] A direct-acting dopamine agonist, bromocriptine, is a potentially effective drug for the treatment of this syndrome, [13] and it has been shown to be successful. [5] Muscle contraction was the most common manifestation after haloperidol in the NMS patients, and the possibility of direct muscular involvement in NMS has been reported.…”

“…[16] The direct toxin to the striated muscles has been observed to be sensitive to the causative drug (haloperidol) to start contractions in the NMS patients. [16] Dantrium ® (dantrolene sodium), a lipid-soluble hydantoin derivative acting as a skeletal muscle relaxant, is the treatment of choice for this syndrome, [13] and it has been shown to be consistently effective for the treatment of NMS. [5] Dantrium ® (dantrolene sodium) was used in our cases except for case 1 who was treated with frequent and long-term hemodialysis.…”

“…[5] ARF associated with NMS was successfully treated with hemodialysis or hemodiafiltration. [12] Hemodialysis effectively cures myoglobulinemic ARF with NMS, [13] and direct hemoperfusion removes the metabolites of neuroleptics. [14] Six patients suffering from schizophrenia who developed myoglobulinemic ARF induced by rhabdomyolysis, were successfully treated by either hemodialysis or hemodiafiltration.…”