A patient started on clozapine develops fever, rigidity, altered consciousness and a creatine kinase of 8000 U/L on day 3. The most appropriate immediate treatment after discontinuing clozapine is:

• A Cyproheptadine and benzodiazepines
• B Dantrolene and bromocriptine ✓
• C Procyclidine and oral hydration
• D Haloperidol at half the prior dose of clozapine

Explanation

The clinical picture — hyperthermia, lead-pipe rigidity, autonomic dysfunction and rhabdomyolysis — is neuroleptic malignant syndrome (NMS). After stopping the causative antipsychotic, dantrolene (reduces muscle rigidity and hyperthermia via ryanodine receptor antagonism) and bromocriptine (restores dopaminergic tone in the hypothalamus and striatum) are the pharmacological treatments of choice. Cyproheptadine is used for serotonin syndrome, not NMS.

Reference: KD Tripathi, Essentials of Medical Pharmacology, 8th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.