Neuroleptic malignant syndrome due to donepezil.pdf
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Abstract
Neuroleptic malignant syndrome (NMS), first described nearly five decades ago, is an idiosyncratic and life-threatening complication of treatment with drugs. NSM is characterized by fever, sever muscle rigidity and autonomic and mental status changes.
Many drugs may cause NMS, most of which are antipsychotic drugs. NMS can also be developed when dopaminergic drugs are suddenly withdrawn; in addition, there are other drugs that don’t belong to any of the above categories that may cause NMS.
An 80 years old male patient was admitted to our Emergency Department for intermittent fever with onset from three days.
His medications included amlodipine, oral steroid, and donepezil, which was administered at the dose of 10 mg/day. At the time of admission, the patient showed stupor without other relevant signs at the physical exam.
Infectious diseases and systemic diseases were ruled out during the course. During the following ten hours after the admission, the patient experienced a further worsening of the fever to a stable level of 42°.
The neurological exam showed diffuse severe muscular stiffness and bilateral fixed miose.
A lumbar puncture was also performed that was negative. He died a few hours later.
An autopsy was also carried out and it did not show the reported results. Based on the findings in our patient and from the literature data, we hypothesize that the patient developed a NMS due to Donepezil.
This indicates that when we face with patients with altered mental state, fever, muscle stiffness and/or autonomous instability, an accurate medical history is required and we must consider Donepezil as a potential cause of suspected NMS.
LEARNING POINTS
- Neuroleptic malignant syndrome (NMS) is an uncommon and potentially fatal complication of neuroleptic treatment.
- Donepezil may cause an imbalance between the dopaminergic and cholinergic systems resulting in adverse neurological reactions because of its pharmacological properties
- Donepezil should be considered as possible cause of NMS
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References
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