Neuroleptic Malignant Syndrome: What You Need to Know

When working with Neuroleptic Malignant Syndrome, a rare but potentially fatal reaction triggered by dopamine‑blocking antipsychotics. Also known as NMS, it demands rapid recognition and treatment.

This condition Neuroleptic Malignant Syndrome encompasses severe hyperthermia, muscle rigidity, autonomic instability and altered mental status. The underlying trigger is often dopamine blockade, the inhibition of dopamine receptors by medications such as haloperidol, risperidone or chlorpromazine. When dopamine signaling drops sharply, the hypothalamus can’t regulate temperature, leading to dangerous spikes in body heat. At the same time, excess muscle activity drives rhabdomyolysis, which releases creatine kinase (CK) into the bloodstream and can cause kidney injury.

Key Players and How They Interact

Most cases involve antipsychotic drugs, medications used for schizophrenia, bipolar disorder and other psychoses that work by blocking dopamine D2 receptors. These agents are essential for many patients, but their potency means clinicians must watch for early warning signs like sudden sweating, tremor or confusion. Autonomic instability, fluctuations in blood pressure, heart rate and breathing that accompany NMS often follows the same pathway, reflecting the nervous system’s loss of dopamine balance. Hyperthermia, muscle rigidity and elevated CK levels form a clinical triad that signals the need for immediate intervention.

Because NMS requires swift action, the first step is to stop the offending antipsychotic and start supportive care—cooling blankets, IV fluids, and monitoring of electrolytes. In many hospitals, clinicians add medications that restore dopamine function, such as bromocriptine, or block muscle breakdown, like dantrolene. Early recognition can prevent complications like renal failure, respiratory distress or even death. The syndrome’s rarity makes it easy to miss, but keeping the relationship between dopamine blockade and hyperthermia in mind helps clinicians act quickly.

Below you’ll find a curated list of articles that dive deeper into each aspect of this condition—from the pharmacology of antipsychotic drugs to practical tips for managing hyperthermia and monitoring rhabdomyolysis. Whether you’re a healthcare professional looking for a quick refresher or a patient seeking clear explanations, the posts ahead cover the full spectrum of NMS knowledge.