Neuroleptic Malignant Syndrome Secondary to Quetiapine

Abstract

NMS with associated EPS has been previously associated with quetiapine. Clinicians should be aware that NMS with EPS can occur with quetiapine at steady state doses without recent dosage adjustments or titration.

Dispensed prescriptions for quetiapine and other second-generation antipsychotics in Canada from 2005 to 2012: a descriptive study

“…4,37 The risk of developing a severe movement disorder when using quetiapine at lower doses (e.g., 25-150 mg/d) in the treatment of anxiety and sleep disturbance has not been sufficiently investigated. Quetiapine is well recognized for its ability to exacerbate cardiovascular risk factors, including hypertension, dyslipidemia and obesity, even when used at lower doses for insomnia.…”

The Role of Atypical Antipsychotics in Neuroleptic Malignant Syndrome: Report of Two Cases and Review of the Literature

“…Ayırıcı tanının; içinde infeksiyonlar, serebrovasküler olaylar, nöbet, Parkinson hastalığı, katatoni ve hepatik ensefalopatinin de bulunduğu geniş bir hastalık grubunun arasından yapılması gerekmektedir (5). Özellikle merkezi sinir sistemi infeksiyonların dışlanması için lomber ponksiyon uygulanması önemlidir.…”

“…Literatürde, ketiapine bağlı NMS olguları benzer şekilde sıkça bildirilmektedir (2,3,5). Detweiler ve arkadaşlarının çalışmasının sonuçlarına göre, yedi farklı sınıflama sisteminde yapılan tanısal uygunluk analizinde, vakaların tümünün tüm sınıflama kriterlerini içermediği gösterilmiştir.…”

Neuroleptic malignant syndrome

“…Mortality and morbidity associated with NMS can be further reduced by increased awareness of its initial clinical symptoms and signs, allowing for prompt clinical menagement 33 . Newer agents, typically regarded as safe, are also not uncommonly related to NMS and the use of these AP should not preclude diagnostic suspicion 4,11,[14][15][16][17] .…”

“…NMS is classically associated with the use of high-potency antipsychotics (AP), such as butyrophenones and phenothiazines, but has also been described with newer agents, commonly described as "atypical" AP (risperidone, olanzapine, quetiapine), other D2-receptor antagonists (metoclopramide) and following withdrawal of anti dopaminergic agents [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] . Although the precise pathophysiologic mechanism underlying NMS remains unknown, a reduction in dopaminergic activity in the brain probably by dopamine D2 receptor blockade in the striatum and hypothal-amus is generally assumed as a potential cause 4,20 .…”