Neuroleptic Malignant Syndrome with Ziprasidone

Murty, Radhika G.; Mistry, Sandeep; Chacko, Ranjit C.

doi:10.1097/00004714-200212000-00015

Cited by 26 publications

(14 citation statements)

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“…Six cases of ziprasidone-induced NMS (ZPR-NMS) were included [67–72], whereas a previous review examined five cases [6]. The mean age of patients was 35 years; two-thirds of patients were females and the same proportion was diagnosed with a psychotic disorder.…”

Section: Discussionmentioning

confidence: 99%

Second-Generation Antipsychotics and Neuroleptic Malignant Syndrome: Systematic Review and Case Report Analysis

et al. 2015

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BackgroundNeuroleptic malignant syndrome (NMS) is a rare, severe, idiosyncratic adverse reaction to antipsychotics. Second-generation antipsychotics (SGAs) were originally assumed to be free from the risk of causing NMS, however several cases of NMS induced by SGAs (SGA-NMS) have been reported.ObjectivesThe aim of this study was to systematically review available studies and case reports on SGA-NMS and compare the presentation of NMS induced by different SGAs.Data SourcesCitations were retrieved from PubMed up to November 2013, and from reference lists of relevant citations.Study Eligibility CriteriaEligibility criteria included (a) primary studies reporting data on NMS, with at least 50 % of the sample receiving SGAs; or (b) case reports and case reviews reporting on NMS induced by SGA monotherapy, excluding those due to antipsychotic withdrawal.Study Appraisal and Synthesis MethodsA standardized method for data extraction and coding was developed for the analysis of eligible case reports.ResultsSix primary studies and 186 individual cases of NMS induced by SGAs were included. Primary studies suggest that SGA-NMS is characterized by lower incidence, lower clinical severity, and less frequent lethal outcome than NMS induced by first-generation antipsychotics. Systematic analysis of case reports suggests that even the most recently marketed antipsychotics are not free from the risk of inducing NMS. Furthermore, clozapine-, aripiprazole- and amisulpride-induced NMS can present with atypical features more frequently than other SGA-NMS, i.e. displaying less intense extrapyramidal symptoms or high fever.LimitationsCase reports report non-systematic data, therefore analyses may be subject to bias.Conclusions and Implications of Key FindingsClinicians should be aware that NMS is virtually associated with all antipsychotics, including those most recently marketed. Although apparently less severe than NMS induced by older antipsychotics, SGA-NMS still represent a relevant clinical issue.Electronic supplementary materialThe online version of this article (doi:10.1007/s40268-014-0078-0) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Second-Generation Antipsychotics and Neuroleptic Malignant Syndrome: Systematic Review and Case Report Analysis

et al. 2015

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“…The one case report of NMS in PD precipitated by neuroleptic medication was secondary to haloperidol administration (Ryken and Merrell, 1989). In addition, there is only one prior case report of NMS secondary to administration of ziprasidone in any patient (Murty et al, 2002), and none in PD prior to this report. Ziprasidone is a combined serotonin and dopamine receptor antagonist that is reported to have minimal motor, cognitive, weight gain, prolactin related or anticholinergic side effects (Seeger et al, 1995).…”

Section: Introductionmentioning

confidence: 86%

Ziprasidone‐related neuroleptic malignant syndrome in a patient with Parkinson's disease: a diagnostic challenge

Gray

2004

Human Psychopharmacology

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“…As for ziprasidone, at least six cases of probable NMS in association with its use have also been reported so far [39][40][41][42][43][44]. There have been two case reports of NMS in connection with perospirone [45,46], another serotonin-dopamine antagonist which was developed by a Japanese pharmaceutical company and has been available as an atypical antipsychotic drug solely in Japan [47].…”

Section: Nms Associated With Atypical Antipsy-choticsmentioning

confidence: 99%

Atypical Neuroleptic Malignant Syndrome or Serotonin Toxicity Associated with Atypical Antipsychotics?

Odagaki

2009

CDS

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Atypical antipsychotics and selective serotonin reuptake inhibitors (SSRIs) have been prescribed extensively, often in combination with each other. When toxic encephalopathy develops with neuromuscular and autonomic symptoms in a patient taking medication including atypical antipsychotics, it has tended to be diagnosed as neuroleptic malignant syndrome (NMS). However, there have recently been several case reports where the diagnosis of serotonin syndrome is given or raised as a likely differential diagnosis to such cases. In the present review, the author addressed himself to the issues surrounding the neurotoxic reaction to the treatment regimen containing atypical antipsychotics, focusing on the "atypical" forms of NMS and pathophysiological as well as clinical features of serotonin toxicity. Although NMS is idiosyncratic in nature, it appears practically useful to comprehend this syndrome as a spectrum-based concept. Likewise, serotonin toxicity is a broad spectrum of clinical syndromes in close connection with serotomimetic drug use, including varied severity. Some of atypical antipsychotics, i.e., perospirone, aripiprazole, ziprasidone, clozapine, and quetiapine, have been shown to behave as partial agonists at 5-HT1A receptors, providing direct evidence that these atypical antipsychotics are serotomimetic per se. The reciprocal interaction between the dopaminergic and serotonergic systems disturbed by either dopaminergic blockers or serotonergic enhancers leads to the disruption of homeostasis, with typical forms of NMS and serotonin syndrome representing the ends of the common pathophysiological background. The practical and flexible way to consider and manage such cases with updated knowledge derived from basic research should be warranted to be beneficial to our patients.

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Neuroleptic Malignant Syndrome with Ziprasidone

Cited by 26 publications

References 9 publications

Second-Generation Antipsychotics and Neuroleptic Malignant Syndrome: Systematic Review and Case Report Analysis

Second-Generation Antipsychotics and Neuroleptic Malignant Syndrome: Systematic Review and Case Report Analysis

Ziprasidone‐related neuroleptic malignant syndrome in a patient with Parkinson's disease: a diagnostic challenge

Atypical Neuroleptic Malignant Syndrome or Serotonin Toxicity Associated with Atypical Antipsychotics?

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